How do you best palliate metastatic skin and subcutaneous melanoma lesions?

As with most palliative radiotherapy, hypofractionation is appropriate for most melanoma metastases in the skin and subcutaneous tissues. When giving palliative radiotherapy to the skin, it is important to be cognizant of the area of skin being irradiated, and underlying organs at risk. Small areas of skin tolerate higher doses of radiation better than large areas of skin.

Systemic therapy can be helpful to patients with unresectable and metastatic melanoma. Examples include (but are not limited to): targeted agents (vemurafenib, dabrafenib, trametinib), immunotherapy (ipilimumab, etc), and more traditional chemotherapy (temozolomide, etc).

The use of these (or other) systemic therapies concurrent with radiotherapy for melanoma should be u...