Treatment of Amelanocytic Melanoma with Satellite or In-Transit Metastases of Cutaneous Origin
This protocol addresses amelanocytic melanoma in patients presenting with satellite metastases or in-transit metastases arising from cutaneous primary tumours — a clinically distinct locoregional pattern requiring specific management decisions.
When satellite or in-transit metastases are resectable, complete excision with clear margins is the primary goal. For unresectable disease, the management approach involves a choice between systemic therapy and local therapeutic strategies, with the selection guided in part by tumour molecular profile.
For unresectable disease, systemic therapy options — informed by BRAF mutation status — represent one treatment pathway. Several local therapy modalities may also be considered as alternatives or additions.
References
DOI: 10.1016/j.annonc.2024.11.006
- Patients with resectable ITMs should undergo complete excision with clear margins [IV, B].
- Patients with unresectable satellite or ITMs may be treated with systemic therapy with anti-PD-1 based immunotherapy or BRAFieMEKi, according to BRAF mutation status [I, A].
- Local therapy with T-VEC, [I, B; ESMO-MCBS v1.1 score: 3], isolated limb infusion or isolated limb perfusion [IV, C], RT [IV, C], electrochemotherapy [IV, C] or limited palliative excision [IV, C] can also be considered (no impact on OS).