Oligometastatic Melanoma: Treatment & Care Options

What is Oligometastatic Melanoma?

The best treatment for metastatic melanoma is evolving all the time. Oligometastatic melanoma deserves special mention because of the potential to proactively eradicate sites of metastatic disease.

Oligometastatic melanoma is a subset of stage IV melanoma where cancer has spread, but only to a limited number of locations. Typically, this means five or fewer metastatic sites. This condition is distinct from widespread metastatic melanoma, and it offers the possibility of proactive treatment with the aim of eradicating all sites of cancer spread.

The concept of oligometastatic disease is increasingly recognised in the treatment of patients with melanoma and other cancers, such as colorectal cancer and non-small-cell lung cancer. It represents a potential window for aggressive local treatment aimed at achieving long-term disease control or even remission.

While this article is about oligometastatic melanoma, the general priniciples can be applied to other metastatic skin cancers such as squamous cell carcinoma.

Stage IV Melanoma and Metastatic Disease

In metastatic disease, melanoma cells have spread from the original skin cancer (cutaneous melanoma) to distant metastases- organs or tissues like the lungs, liver, brain, or lymph nodes. When the number of tumour cells and the sites involved are limited, it may be classified as oligometastatic stage IV melanoma.

Understanding whether a patient has oligometastatic melanoma or widespread metastatic disease helps guide the treatment strategy.

Differences from Widespread Metastatic Melanoma

Patients with oligometastatic melanoma often respond better to local therapy, such as surgical resection or Stereotactic Body Radiation Therapy (SBRT also known as SABR - stereotactic ablative body radiotherapy). These approaches can offer significant tumour response and improved overall survival when combined with effective systemic therapies.

This differs from the traditional view that all metastatic malignant melanoma should be treated only with systemic disease-targeting drugs. With careful decision-making and management of patients, some individuals may achieve long-term disease control.

Diagnosing Oligometastatic Melanoma

Imaging Techniques for Detection

Accurate diagnosis begins with imaging. Common tools include:

• CT scan

• PET scan

• MRI - particularly of the brain

• Ultrasound (for superficial metastases)

These help identify the number, location, and size of metastatic lesions. Repeat imaging may be used to confirm stability or progression.

PET Scans and Biopsies

PET scans are especially useful for evaluating tumour response and identifying spread of the melanoma. Biopsy of suspicious sites confirms diagnosis and may help detect mutations (e.g., BRAF V600).

Identifying Metastatic Sites

Oligometastases can occur in:

• Lung metastases (also known as pulmonary metastases)

• Lymph node regions

• Liver or adrenal glands

• Brain (brain metastases require special attention with stereotactic radiosurgery or neurosurgery)

Metastases in pulmonary or soft tissue locations may be suitable for surgical treatment or SBRT.

Treatment Strategies for Oligometastatic Melanoma

Local Therapies

Surgical Resection

When feasible, surgical management can remove all visible disease e.g. lung metastasectomy. This may offer a chance for prolonged median survival or even cure.

Benefits of Complete Resection

The trial of complete resection in eligible patients has shown:

• Improved median OS (Overall Survival)

• Delayed disease progression

• Lower recurrence rates

Reports from Ann Surg Oncol, Case Reports, and the Southwest Oncology Group support this approach.

Role of Surgery in Survival Outcomes

Patients undergoing complete surgical resection in prospective studies have achieved long-term control, especially when combined with adjuvant therapy.

Radiation Therapy

Stereotactic Body Radiation Therapy (SBRT) or Stereotactic Ablative Body Radiotherapy (SABR)

SBRT, also known as Stereotactic body radiotherapy, delivers high-dose, focused radiation therapy to metastatic lesions with millimetre precision. It can successfully eradicate metastases in a small number of treatments. It’s ideal for:

• Lung metastases

• Bone lesions

• Liver metastases

• Lymph nodes

• Selected brain metastases (using stereotactic radiosurgery)

Stereotactic Radiosurgery for Brain Metastases

When metastatic sites are limited to the brain, stereotactic radiosurgery is preferred over whole-brain radiation. This minimises adverse effects and preserves cognitive function.

Achieving Local Control

Local therapy with SBRT or surgery helps maintain local control, especially when systemic therapy is working elsewhere in the body.

Systemic Therapies

Targeted Therapy

Targeted therapy focuses on BRAF inhibitors and MEK inhibitors in patients with detectable BRAF mutations. These drugs block signals that drive melanoma cell growth.

MEK Inhibitors and Their Role

When used in combination therapy, BRAF and MEK inhibitors can significantly increase median progression-free survival.

Immunotherapy

Checkpoint inhibitors such as nivolumab and ipilimumab enhance the immune responses against melanoma. This form of immunotherapy can be used as:

• Neoadjuvant therapy (before surgery)

• Adjuvant nivolumab (after surgery)

• First-line therapy for metastatic malignant melanoma

Chemotherapy in Specific Cases

While not the mainstay of treatment, chemotherapy may be used in select cases or clinical trials. It’s considered when patients are not candidates for immunotherapy or targeted therapy.

Multidisciplinary Team Approach

Combining Local and Systemic Therapies

Dr. Wilson leads a multidisciplinary team including:

• Surgical oncologists

• Dermatologists

• Specialists in Surgical Oncology and Radiation Oncology

• Nurses and allied healthcare professionals

Together, they tailor treatments using evidence from clinical data, retrospective study, and prospective studies.

Decision-Making for Optimal Outcomes

Each treatment plan is based on:

• Prognostic factors (such as number of metastases and location)

• Univariate analysis from existing research

• Patient preference and general health

This collaborative approach ensures the best possible survival outcomes.

Prognostic Factors and Survival Outcomes

Median Overall Survival (OS)

Studies report median OS for oligometastatic melanoma patients ranging from 20 to 50 months, depending on site and treatment.

Median Progression-Free Survival

Median progression-free survival is often enhanced when local control and systemic disease are treated in parallel.

Key Prognostic Factors

• Number of patients with oligometastatic disease at diagnosis

• Tumour site and confidence interval for recurrence

• Free interval (time between primary diagnosis and metastasis)

Research and Evidence

Retrospective Studies on Surgical Management

Data from retrospective analysis suggest complete resection can improve long-term outcomes.

Prospective Studies on Modern Systemic Therapy

Modern therapies, as published in J Clin Oncol, Cancer Res, and via Elsevier Inc, demonstrate meaningful clinical benefit.

Clinical Data and Case Series

Ongoing clinical data from centres like Moffitt Cancer Center, Royal Marsden, and studies led by Jonathan S. Zager underscore the evolving standard of care.

How Dr James Wilson Can Help

Expertise in Cutting-Edge Treatments

Dr. Wilson is a UK oncologist with deep experience in metastasis-directed therapy, including:

• Stereotactic Body Radiation Therapy

• MR-Linac guided radiotherapy

• Combination systemic and local therapy for oligometastatic disease

Personalised Treatment Plans

Every patient receives a personalised treatment strategy, incorporating:

• Imaging reviews

• Molecular diagnostics

• Multidisciplinary input

Collaborative Multidisciplinary Care

Your care will be planned with experienced teams across leading UK centres, ensuring seamless coordination and expert guidance.

Support and Care for Patients

Dr. Wilson’s clinic offers:

• Practical guidance for managing adverse effects

• Access to support services and ongoing follow-up

• Referrals to clinical trials and ongoing research funding programmes

Importance of Long-term Follow-Up

Survivorship care includes:

• Monitoring for evidence of disease

• Management of long-term side effects

• Emotional and psychological support

• Early, proactive treatment of any sites of disease recurrence

Contact Dr. Wilson for Expert Care

If you've been diagnosed with oligometastatic melanoma, a personalised approach can make all the difference.

Contact Dr. James Wilson to explore your options, including Stereotactic Body Radiation Therapy, surgical consultation, and systemic therapies tailored to your needs.

• Call +44 (0)20 7993 6716

• Email info@drjameswilson.co.uk

• Click here to contact us directly

• Learn more about personalized treatment options and oligometastatic melanoma via our latest articles

Take control of your care with an experienced expert dedicated to treating oligometastatic melanoma.