Metastatic melanoma to the liver: a contemporary and comprehensive review of surgical, systemic, and regional therapeutic options

Cancer. 2014 Mar 15;120(6):781-9. doi: 10.1002/cncr.28480. Epub 2013 Dec 2.


Effective management of hepatic metastases from ocular and cutaneous melanoma remains a major therapeutic challenge. Treatment options include hepatic resection, hepatic intra-arterial (HIA) chemotherapy, chemoembolization, and hepatic perfusions. Evaluating the efficacy of these interventions is limited by the retrospective nature of most of the data, although controlled phase 3 studies are starting to emerge. Studies of hepatic resection are strongly suggestive of a survival benefit following surgery in selected patients. Effective systemic agents for metastatic cutaneous melanoma are available and supported by randomized controlled phase 3 trials. In contrast, no active systemic treatment has yet been identified for metastatic ocular melanoma. HIA and intravenous delivery of fotemustine have been compared in a randomized phase 3 trial in patients with unresectable metastases from melanoma, but no differences between the 2 approaches were observed. Hepatic arterial chemoembolization appears only to be moderately effective according to uncontrolled studies; targeting patients with less liver involvement may improve outcomes. A recent phase 3 study showed a significant improvement in hepatic progression-free survival with percutaneous hepatic perfusion compared with best alternative care in patients with metastatic melanoma; however, the overall survival analysis was confounded by crossover of control patients to active treatment. In conclusion, hepatic resection offers the possibility of long-term survival in carefully selected patients with liver-limited metastases from melanoma. In patients with unresectable cutaneous melanoma, effective systemic therapy is the best treatment option. For patients with unresectable ocular melanoma, regional treatments are likely to assume a greater role until effective systemic treatments are identified.

Keywords: chemoembolization; cutaneous melanoma; hepatic intra-arterial infusion; hepatic metastases; ocular melanoma; perfusion; review; surgery; systemic therapy.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Chemoembolization, Therapeutic
  • Chemotherapy, Cancer, Regional Perfusion
  • Disease-Free Survival
  • Eye Neoplasms / pathology*
  • Humans
  • Infusions, Intra-Arterial
  • Liver / surgery
  • Liver Neoplasms / secondary*
  • Liver Neoplasms / surgery
  • Liver Neoplasms / therapy*
  • Melanoma / secondary*
  • Retrospective Studies
  • Skin Neoplasms / pathology*
  • Treatment Outcome

Supplementary concepts

  • Melanoma, Cutaneous Malignant