This article is clearly and carefully presented in exquisite detail. The authors have succinctly shown that there are occasional patients who benefit from an aggressive approach to stage IV melanoma owing to metastatic disease isolated to the liver. This article must be carefully read to understand how meticulously these patients were selected. Although 5-year disease-free survival and overall survival was 12% and 29% in the group undergoing resection, this represents only 0.3% of the 1750 patients who were evaluated and found to have hepatic metastasis and 18% of those going through a rigorous screening process and thought to be potential resection candidates. It is also important at this time, when the technical capability of performing percutaneous liver ablation exists, to note that 30% of patients were excluded by findings noted only at the time of laparotomy.
Schneider PD. Surgical Resection for Metastatic Melanoma to the Liver—Invited Critique. Arch Surg. 2001;136(8):955. doi:10.1001/archsurg.136.8.955