What is the management of cecal melanoma?

From the Guidelines

The management of cecal melanoma typically involves surgical resection as the primary treatment, usually through a right hemicolectomy with lymph node dissection to remove the tumor and assess for metastatic spread. Following surgery, systemic therapy is recommended, which may include immune checkpoint inhibitors such as pembrolizumab, nivolumab, or ipilimumab, or targeted therapy with BRAF/MEK inhibitors (like dabrafenib plus trametinib) for patients with BRAF mutations, as suggested by the ESMO clinical practice guidelines for diagnosis, treatment, and follow-up of cutaneous melanoma 1. Radiation therapy may be considered for local control in specific cases, such as for patients with brain metastases, where ipilimumab/nivolumab combination therapy is the preferred first-line treatment, also in BRAF-mutated asymptomatic patients 1. Due to the aggressive nature of cecal melanoma, a multidisciplinary approach involving surgical oncologists, medical oncologists, and radiation oncologists is essential, as highlighted in the NCCN guidelines for melanoma 1. Regular surveillance with imaging studies (CT scans every 3-6 months initially) and clinical examinations are necessary to monitor for recurrence, with consideration of adjuvant radiation following lymphadenectomy for stage III melanoma with clinically positive nodes or recurrent disease 1. The prognosis for cecal melanoma is generally poor due to its rarity, late presentation, and aggressive behavior, with most cases representing metastatic disease from cutaneous primary melanomas rather than primary gastrointestinal melanomas, emphasizing the need for early detection and aggressive multimodal treatment to improve outcomes. Key considerations in the management of cecal melanoma include:

• Surgical resection as the primary treatment
• Systemic therapy with immune checkpoint inhibitors or targeted therapy
• Radiation therapy for local control in specific cases
• Multidisciplinary approach involving surgical, medical, and radiation oncologists
• Regular surveillance for recurrence
• Consideration of adjuvant radiation for high-risk patients.

From the Research

Management of Cecal Melanoma

• The management of cecal melanoma involves a multidisciplinary approach, with surgery being the mainstay of treatment for patients with resectable disease 2.
• For patients with stage III resectable melanoma, postoperative systemic adjuvant therapy may be considered to target residual micrometastatic disease and reduce the risk of recurrence 3.
• The use of targeted therapies, such as BRAF-MEK inhibitors, and immunotherapies, such as anti-programmed cell death protein 1, may also be considered in the management of cecal melanoma 3, 4.
• Surgical resection of metastatic melanoma may be performed for curative or palliative intent, and candidates for surgical resection generally have favorable prognostic factors 5.
• The current standards of surgical management in primary melanoma involve wide excision with 1-2 cm margins, depending on the depth of the tumor, and sentinel lymph node biopsy may be indicated for patients with clinically node-negative, intermediate-thickness primary melanomas 6.

Treatment Options

• Surgical management, including wide excision and sentinel lymph node biopsy, is a well-established treatment option for clinically localized melanoma 2, 6.
• Adjuvant therapies, such as high-dose interferon α and anti-cytotoxic T-lymphocyte antigen 4 ipilimumab, may be considered for patients with stage III melanoma 3.
• Targeted therapies, such as vemurafenib and dabrafenib, and immunotherapies, such as ipilimumab and nivolumab, may be considered for patients with unresectable melanoma 4.
• Neoadjuvant therapy may also be considered for patients with clinically or radiologically detectable locoregionally advanced disease 3.