The role of stereotactic radiosurgery in combination with immunotherapy for metastatic melanoma following palliative surgery: a case report and review of the literature.

Surgery has a pivotal role in management of patients with metastatic melanoma. Historically, surgical resection was the only potential for cure. However, new immunotherapies also offer a survival advantage in combination with surgery. A 49-year-old female presented with complaints of diarrhea, headaches, and a cutaneous lesion. Computed tomography (CT) scan of the head revealed severe intracranial metastatic disease with significant associated vasogenic edema. CT of the chest, abdomen, and pelvis identified diffuse metastatic disease burden with numerous intrapulmonary metastases, a large left adrenal mass, an enlarged left inguinal lymph node, a small right breast mass, and numerous cutaneous, subcutaneous, and intramuscular metastatic implants, the largest measuring 3.6 × 9.1 × 8.5 cm in the lumbar region. Wide local excision of the back mass was performed. Pathology indicated malignant melanoma with negative margins. The patient also underwent stereotactic radiosurgery (SRS) and treatment with immunotherapy. 28 months after initial wide local excision, the patient is still alive and able to perform activities of daily living. Most recent brain imaging shows a positive response to therapy with the patient's cancer in remission. Therefore, in carefully selected patients, a survival benefit and improved quality of life may be seen with metastasectomy.