Surgery for Skin Metastases
CO2 Laser Treatments
Rrepeated laser treatment can achieve adequate regional control of skin metastases with little morbidity. CO2 laser is recommended as a first-line treatment to patients with small but numerous cutaneous satellite or in-transit lesions in whom other surgery would induce substantial morbidity.
Metastases to the skin are rare. Albeit rarely, surgical excision, particularly MOHS micrographic surgery, has been used for the removal of isolated cutaneous metastases. In the appropriate setting, surgical excision of isolated cutaneous metastases using microscopically controlled margins at the time of surgery should be added to the indications for MOHS surgery.
Local control of in-transit metastasis should be achieved with MOHS technique or some other surgical method where surgical margins are rigorously evaluated for residual tumor, perineural extension or intravascular invasion. (e.g. excision with intraoperative frozen section control or excision with postoperative margin assessment). Post operative radiation should be strongly considered. The radiation field often involves the primary tumor site, the in-transit metastatic site, and the draining lymph node basin.