Keith A. Delman, MD

Here we review some of the most significant changes in the surgical management of melanoma that have reduced morbidity and thereby improved patient outcomes.

The authors provide a timely and relevant review of the role that the immune system plays in regulating tumor growth and how immune modulation can alter tumor response. This review follows from the recently published phase III trial of ipilimumab,[1] a monoclonal antibody to cytotoxic T-lymphocyte antigen 4 (CTLA-4) and the first therapy in several decades to produce prolonged overall survival (OS) in patients with metastatic melanoma. While this outcome underscores the importance of this therapy in treating metastatic melanoma, its clinical applicability, at least on a widespread level, necessitates further exploration.

Small bowel metastases from melanoma are uncommon. While the authors reference two studies that reported a large proportion of patients with small bowel metastases, the true incidence of gastrointestinal (GI) lesions in melanoma patients is much lower.