Abstract
The 245 patients with malignant melanomas treated at Shinshu University from 2000 to 2009 were reviewed. The patients with metastasis had been treated with conventional cytotoxic regimens and/or radiation but not with anti-CTLA-4 antibodies, anti-PD-1 antibodies or BRAF inhibitors. The disease-specific five-year survival rate was 100% among the stage 0 patients, 98% in stage I, 82% in stage II, 59% in stage III, and 18% in stage IV. Postoperative metastasis occurred in 51 patients. The median period until an initial metastasis was 13 months. The first metastasis occurred within 1 year in 49% of the patients, and at ≥5 years in 12% of the patients. The locations of initial metastases (the ratio of patients with metastasis in a particular organ to the total number of patients) were as follows: lung in 55%, skin and subcutis in 35%, lymph nodes in 24%, and brain in 12%. The methods that detected first metastasis were as follows: regular images (CT or PET) without any symptoms in 89% of lung metastasis and 64% of lymph node metastasis, and physical examination in 94% of skin and subcutaneous metastasis. These results suggest that the long-term follow-up with physical examinations and regular lung imaging are important for managing malignant melanoma patients. In addition, these data may be useful as a benchmark for comparing survival benefits afforded by novel therapies including immune-check-point inhibitors and molecular-target therapies, the use of which has begun in Japan.
