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Local Melanoma Recurrence, Satellitosis, and In-transit Metastasis: Incidence, Outcomes, and Selection of Treatment Options

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Cutaneous Melanoma

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Abstract

The most frequent site of first melanoma recurrence is locoregional, and this is frequently a harbinger of systemic recurrence. Local recurrence, satellitosis, and in-transit metastasis are all now understood to be forms of “intralymphatic” metastasis, with similar prognostic implications, a concept incorporated in the most recent 8th Edition (2017) AJCC Melanoma Staging System. In some patients with locoregional melanoma recurrence, however, systemic metastasis never occurs. In these patients and in those with troublesome symptoms from their locoregionally recurrent disease, effective treatment is clearly important. If it is easily possible, complete surgical excision is the best option, but if it is not, there is a range of other options, which include local, regional, and systemic therapies. The choice of treatment is guided by the number of lesions, their anatomic location, whether they are cutaneous or subcutaneous, their size, and the presence or absence of metastatic disease in regional lymph nodes or at distant sites. Local therapies include topical therapies, cryotherapy, diathermy-fulguration, laser ablation, radio-frequency ablation, intralesional injection of vaccines or cytotoxic agents, and electrochemotherapy. Regional therapies include isolated limb perfusion, isolated limb infusion and radiation therapy. Even amputation may occasionally be considered. An understanding of the options, and the benefits and disadvantages of each, will allow selection of the most appropriate treatment strategy for each patient with local melanoma recurrence, satellitosis, or in-transit metastasis.

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Authors and Affiliations

  1. Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia

    John F. Thompson

  2. Department Melanoma and Soft Tissue, Istituto Nazionale dei Tumori, Napoli, Italy

    Nicola Mozzillo

  3. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Merrick I. Ross

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  1. John F. Thompson
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  2. Nicola Mozzillo
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  3. Merrick I. Ross
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Correspondence to John F. Thompson .

Editor information

Editors and Affiliations

  1. Division of Surgical Oncology, University of Texas Southwestern, Dallas, TX, USA

    Charles Balch

  2. Division of Surgery, UT MD Anderson Cancer Center, Houston, TX, USA

    Jeffrey Gershenwald

  3. Melanoma Institute of Australia, Wollstonecraft, Australia

    John Thompson

  4. Georgetown Medical Center, Washington, DC, USA

    Michael Atkins

  5. Melanoma and Skin Cancer Program, University of Pittsburgh, Pittsburgh, PA, USA

    John Kirkwood

  6. University of Sydney, Sydney, NSW, Australia

    Richard Kefford

  7. Department of Dermatology, Harvard Medical Center, Boston, MA, USA

    Arthur Sober

  8. Department of Dermatology, Memorial Sloan Kettering, New York, NY, USA

    Allan Halpern

  9. Department of Dermatology, University Hospital, Tübingen, Tübingen, Germany

    Claus Garbe

  10. Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown NSW, Australia

    Richard Scolyer

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Thompson, J.F., Mozzillo, N., Ross, M.I. (2019). Local Melanoma Recurrence, Satellitosis, and In-transit Metastasis: Incidence, Outcomes, and Selection of Treatment Options. In: Balch, C., et al. Cutaneous Melanoma. Springer, Cham. https://doi.org/10.1007/978-3-319-46029-1_32-1

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