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Operative Management of Metastatic Melanoma in Bone May Require En Bloc Resection of Disease

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Bone metastasis is a poor prognostic indicator in melanoma. Some authors have advocated only palliative treatment for patients with osseous disease.

Questions/purposes

We determined (1) overall survival after surgery for bone metastasis in patients with malignant melanoma, (2) the rate of local relapse after surgery for bone metastasis, (3) whether certain patients might benefit from more extensive surgery to reduce the risk of local recurrence, and (4) whether there is an effect of prior radiation on survival and local progression.

Methods

We identified 37 patients who underwent 41 orthopaedic procedures for metastatic melanoma to bone in the pelvis or appendicular skeleton, including 20 for pathologic fracture, from our institutional orthopaedic database and performed a retrospective review of their charts and radiographs. The femur (n = 19) and humerus (n = 11) were the most common operative sites. Kaplan-Meier survivorship was used to determine overall survival and local progression-free survival.

Results

The median survival from surgery was 9 months (range, 1–135 months). Kaplan-Meier analysis showed overall survival of 30% at 12 months and 17% at 24 months. Local recurrence developed in seven of 41 lesions (17%). The local progression-free survival was 87% at 12 months and 67% at 24 months. Patients for whom prior radiation failed and patients who did not have excision of osseous metastases had higher rates of local recurrence. Two patients underwent amputation for uncontrolled local progression of disease.

Conclusions

Osseous metastasis from melanoma behaves aggressively. The rate of local progression is substantial, and two of 37 patients in this series required amputation for progressive disease. Despite the poor overall prognosis, local control of bone disease is an important issue, and patients may benefit from resection of osseous metastases, particularly if prior radiation has failed.

Level of Evidence

Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Santa Clara Valley Medical Center, San Jose, CA, USA

    Jeffrey E. Krygier MD

  2. Department of Orthopaedic Oncology, University of Texas MD Anderson Cancer Center, Unit 1448, Houston, TX, 77230, USA

    Valerae O. Lewis MD, Robert L. Satcher MD, Bryan S. Moon MD & Patrick P. Lin MD

  3. The Polyclinic Madison Center, Seattle, WA, USA

    Christopher P. Cannon MD

  4. Stanford University School of Medicine, Stanford, CA, USA

    Jeffrey E. Krygier MD

Authors
  1. Jeffrey E. Krygier MD
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  2. Valerae O. Lewis MD
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  3. Christopher P. Cannon MD
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  4. Robert L. Satcher MD
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  5. Bryan S. Moon MD
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  6. Patrick P. Lin MD
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Corresponding author

Correspondence to Patrick P. Lin MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research ® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at the University of Texas MD Anderson Cancer Center, Houston, TX, USA.

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Krygier, J.E., Lewis, V.O., Cannon, C.P. et al. Operative Management of Metastatic Melanoma in Bone May Require En Bloc Resection of Disease. Clin Orthop Relat Res 472, 3196–3203 (2014). https://doi.org/10.1007/s11999-014-3761-0

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  • DOI: https://doi.org/10.1007/s11999-014-3761-0

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