Metastatic, or stage IV, MM is a devastating disease. It is defined by dissemination of the cutaneous tumour to other organs or nonregional lymph nodes. The skin, subcutaneous tissues and lymph nodes are the first site of metastatic disease in 59% of patients. When haematogenous spread to liver, bone and brain occurs the natural history is that of one of the most aggressive of all malignant diseases.
For all patients with metastatic disease, the median survival is approximately 7 months; 25% will be alive after 1 year and only 5% of patients will be alive 5 years after diagnosis. Patients with a higher performance status (a numerical measure of physical fitness) and women have a better prognosis (P = 0-001 and P = 0-056, respectively).1,2 Survival is also better in patients with a longer duration of remission after primary disease, fewer metastatic sites involved and in those with non-visceral disease (see Table 24.1).
The intention of treatment remains palliative in all but a few patients. A patient who is fit enough to tolerate systemic therapy will often choose active therapy despite the modest responses seen with such treatment. The aim of therapy should clearly be to optimise a patient's quality of survival, and must therefore take into account the morbidity and convenience of therapy.
Is there a preferred systemic therapy in metastatic melanoma?
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Complete Guide to Preventing Skin Cancer. We all know enough to fear the name, just as we do the words tumor and malignant. But apart from that, most of us know very little at all about cancer, especially skin cancer in itself. If I were to ask you to tell me about skin cancer right now, what would you say? Apart from the fact that its a cancer on the skin, that is.