Melanoma
Kristen E. Rhodin, MD
General Surgery Resident
Duke University Medical Center
Durham, North Carolina, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
In transit melanoma (ITM) is a heterogeneous disease with many treatment options. Management strategies for ITM have included regionally directed therapies with recent introduction of effective modern immunotherapy (immune checkpoint inhibitors [ICI]), Herein, we aimed to characterize disease progression, trends in management of ITM, and their impact on survival.
Methods:
Retrospective review was conducted on patients with ITM who received treatment at our institution from 1991-2021. Primary tumor characteristics, recurrences, treatment strategies, and survival data were collected. The primary objective was to compare trends in management of ITM. Frequency of each treatment strategy was plotted by year. Kaplan-Meier survival analysis was used to compare overall survival (OS) between patients who had received modern immunotherapy (ICI) at any point during their treatment to those who had not.
Results:
Altogether 184 patients with ITM were identified. Median year of initial diagnosis was 2007 (IQR 2003, 2011) with a median Breslow depth of 2.65 mm (IQR 1.70, 4.70). Median year of first ITM recurrence was 2009 (IQR 2006, 2013). 160 (89.1%) patients experienced more than 1 ITM recurrence. At any time during ITM disease, 138 (75%) patients had involvement of regional lymph nodes, 83 (45.1%) developed distant metastasis, while 35 (19.0%) had ITM only at median follow up of 2.9 years. The most common treatments for patients with ITM included: surgical excision (N=145, 78.8%), isolated limb infusion (ILI) (N=136, 73.9%), ICI (N=63, 34.2%), and TVEC (N=32, 17.4%). Within this cohort, 81.3% (N=178/219) of surgical excisions and 80.2% (N=130/162) of ILI were performed prior to 2012, with increasing ICI and TVEC utilization after 2012 and 2015, respectively. Patients who received ICI had significantly improved OS compared to those not receiving ICI (Figure), with 65.1% versus 29.0% 10-year survival, respectively.
Conclusions:
Patients with ITM remain a heterogeneous population with variable disease progression. Management of ITM has shifted in the past decade with the introduction of modern therapies. Receipt of ICI was associated with improved survival for patients with ITM.