Melanoma
ICD-10 C43 · ICD-11 2C30

Treatment of Melanoma with In-Transit or Satellite Metastases

Clinical Scenario

This protocol covers melanoma patients presenting with in-transit metastases (ITMs) or satellite metastases — locoregional tumour deposits that arise between the primary site and the regional lymph node basin, or immediately adjacent to the primary lesion. A critical branch point in management is whether these lesions are resectable.

Approach Overview

For resectable in-transit metastases, a surgical strategy forms the basis of management. For unresectable satellite or in-transit metastases, the choice of systemic therapy is informed by BRAF mutation status; local therapeutic options can also be considered in appropriate cases.

Full regimen details, sequencing, evidence grades, and local therapy options are available in the protocol…

Instant Access to Structured Evidence-Based Regimens

References

  1. Patients with resectable ITMs should undergo complete excision with clear margins [IV, B].
  2. 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].
  3. 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).
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