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Long-term Survival and Occasional Regression of Distant Melanoma Metastases after Adrenal Metastasectomy

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Human melanoma cells express high-affinity glucocorticoid receptors, and adrenalectomy has been shown to have antimelanoma effects in animal models. Long-term regression of distant metastatic melanoma was observed in one patient after bilateral adrenalectomy, prompting a review of adrenalectomy for melanoma metastases performed at this center.

Methods

A retrospective study in which all patients treated at the Sydney Melanoma Unit and recorded as having adrenal gland metastases between January 1987 and January 2004 were identified and their survival analyzed.

Results

One hundred eighty-six patients with adrenal gland metastases were identified. Adrenalectomy was performed in 23 patients; the other 163 patients were treated nonsurgically. The adrenal glands were the sole site of disease in five patients. All symptomatic patients were free of pain after recovery from the surgical procedure. Thirteen patients were rendered clinically and radiologically disease-free by their surgery. There was no postoperative mortality within 30 days. Median overall survival after adrenalectomy was 16 months (2-year survival, 39%), compared with 5 months for patients with documented adrenal metastases treated nonsurgically (P < .00001). In one patient, nonresected visceral metastases elsewhere regressed completely after bilateral adrenalectomy; he remained well and free of disease 80 months after adrenalectomy. Regression of distant visceral metasatatic disease also occurred in a second patient after unilateral adrenalectomy.

Conclusions

Adrenalectomy for melanoma metastatic to the adrenal gland provides good palliation of symptoms and is associated with prolonged survival in a selected cohort of patients. We report for the first time sustained complete regression of distant metastatic melanoma after bilateral adrenalectomy, suggesting a possible role for adrenal hormones in modifying melanoma progression in certain patients.

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ACKNOWLEDGMENTS

Supported in part by the Melanoma Foundation of the University of Sydney and the Melanoma and Skin Cancer Research Institute. J.H.W. de Wilt was a fellow in surgical oncology supported by a grant from the Dutch Cancer Society. The authors thank Marjorie Colman for her assistance with the data retrieval and statistical analysis.

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Authors and Affiliations

  1. Sydney Melanoma Unit, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia

    F. J. Collinson MBChB, T. K. Lam MBBS, W. M. J. Bruijn MD, PhD, J. H. W. de Wilt MD, PhD, M. Lamont MBBS, J. F. Thompson MBBS, MD & R. F. Kefford MBBS, PhD

  2. Royal Prince Alfred Hospital, Camperdown, NSW, Australia

    J. F. Thompson MBBS, MD

  3. Westmead Hospital, Westmead, NSW, Australia

    F. J. Collinson MBChB, M. Lamont MBBS & R. F. Kefford MBBS, PhD

  4. Discipline of Surgery, The University of Sydney, NSW, Australia

    J. F. Thompson MBBS, MD

  5. Discipline of Medicine, The University of Sydney, NSW, Australia

    R. F. Kefford MBBS, PhD

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  1. F. J. Collinson MBChB
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  2. T. K. Lam MBBS
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  6. J. F. Thompson MBBS, MD
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Correspondence to J. F. Thompson MBBS, MD.

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Collinson, F.J., Lam, T.K., Bruijn, W.M.J. et al. Long-term Survival and Occasional Regression of Distant Melanoma Metastases after Adrenal Metastasectomy. Ann Surg Oncol 15, 1741–1749 (2008). https://doi.org/10.1245/s10434-008-9836-y

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