Melanoma adrenal metastasis: natural history and surgical management

Background: Few data exist regarding melanoma metastasis to the adrenal gland. We reviewed our experience to determine the natural history of this condition and the appropriate role for surgical intervention. Methods: A retrospective review of melanoma patients with adrenal metastasis was performed. Clinical presentation, surgical treatment, and survival were determined. Results: One hundred fifty-four patients with adrenal metastasis were identified. The median survival for the entire group was 6.4 months and was negatively impacted by the presence of synchronous metastasis or an elevated LDH. Twenty-two patients underwent surgery including 20 patients rendered disease free, either by adrenalectomy alone (14) or adrenalectomy with concomitant metastectomy (6). Patients who underwent surgery had an improved survival compared with those managed nonoperatively (P < .0001). Conclusions: Patients with melanoma adrenal metastasis have a poor prognosis. Surgical treatment should be considered only in highly selected patients, such as those with limited extra-adrenal metastatic disease who can be rendered disease free.