Does Surgery Cure Melanoma? Re-evaluation of Melanoma Surgery Based on a New Progression Model

Abstract

Surgery remains as a mainstream treatment in current melanoma therapy. Most surgeries for melanoma aim to eradicate all melanoma cells in the body, leading to the “cure” of patients. However, recent investigations reveal that melanoma cells disseminate early and form single-cell metastases or micrometastases, which remain dormant for long periods of time (parallel progression model). Furthermore, metastasis may be a multidirectional process whereby cancer cells can seed distant sites as well as the primary tumor itself (tumor self-seeding). Reframing our understanding of melanoma biology urges a review of current therapeutic routines for melanoma. While excision of a primary tumor could prevent melanoma progression by interfering tumor self-seeding even in patients with stage IV disease, the role of complete lymph node dissection following a positive sentinel node biopsy should be reconsidered.