Making decisions on resectability and injectability status of lesions in the management of advanced melanoma in Germany, France and the UK.

There is anecdotal evidence of variation in the treatment of patients with metastatic melanoma. We aimed to describe the decision-making process physicians use to define resectability and injectability in patients with metastatic melanoma, and to identify patient characteristics associated with unresectable and injectable lesions. Physicians in Germany, France and the UK who manage patients with metastatic melanoma completed a questionnaire and case report forms on lesion resectability and injectability. In total, 122 physicians participated in the study, collecting data on 1,193 patients. Physicians' resection history was the main factor impacting their resection decisions; those who had frequently performed resections in the past were more likely to consider a lesion resectable than those who had rarely performed resections. A physician's decision to resect varied according to field of expertise; 46% of oncologists rarely performed resections, but this was the case for only 10% of dermatologists and 26% of dermato-oncologists. Another important factor affecting resectability status was the number of in-transit lesions; 49% of patients with three or more in-transit lesions were considered resectable compared with 73% of patients with fewer than three in-transit lesions. Lesion location impacted on injectability status; cutaneous and regional lymph node lesions were often considered injectable, whereas distant lesions in the bone, brain, lung, and liver were considered uninjectable. Assessment of resectability status was influenced by physicians' resection history; this varied according to field of expertise, and may reflect the lack of clear guidance on resection for patients with advanced melanoma.