# Surgical Management of Stage IV Melanoma: Clinical, Molecular, and Therapeutic Considerations

## TL;DR

This paper reviews the role of surgery in treating advanced melanoma, focusing on clinical factors, molecular insights, and how surgery integrates with modern therapies.

## Contribution

The paper provides a comprehensive overview of surgical strategies in metastatic melanoma, incorporating molecular and clinical advancements.

## Key findings

- Surgery remains a valuable treatment option for metastatic melanoma despite advances in systemic therapy.
- Molecular and biochemical factors influence melanoma tumor biology and patient selection for surgery.
- Emerging tools like gene expression profiling and circulating tumor DNA help guide surgical and therapeutic decisions.

## Abstract

Despite major advances in systemic therapy, surgery still plays a valuable role in the management of metastatic melanoma. This review summarizes the historical evolution of surgical management, outlines the traditional clinical risk factors, and examines biochemical, molecular, and mutational factors that impact melanoma tumor biology. Emerging tools such as predictive biomarker assays, gene expression profiling, and circulating tumor DNA are discussed in the context of patient selection. Finally, we consider contemporary indications for surgery, the management of oligoprogression, sequence of treatment, and optimal timing of resection while highlighting how operative intervention integrates with modern melanoma care.