Abstract
Electrochemotherapy (ECT) is a locoregional cancer treatment primarily used in the palliative management of cutaneous metastases from malignant melanoma. However, its clinical effectiveness, safety, and cost-effectiveness in this setting are poorly defined. The aim of this systematic review is to assess the clinical effectiveness, safety, quality of life (QoL) outcomes, and cost-effectiveness of ECT in the treatment of locally advanced stage III/IV melanoma with in-transit metastasis or loco-regional recurrence. A literature search of MEDLINE and Embase from 2005 to 2024 was performed using the keywords "electrochemotherapy" and "skin cancer". After duplicate removal, 708 studies were identified, 107 English-language papers from 2020 to 2024 were screened, with 47 full texts reviewed. Ten studies met the inclusion criteria and were included for review. Data extraction and reporting adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. ECT achieved complete response (CR) rates of 24-85.7%, overall response rates (ORRs) of 63-100%, and one-year overall survival of 60.4-92.6%. ECT was well tolerated with minimal systemic toxicity and minor adverse effects. QoL was maintained post-treatment, and cost-effectiveness analysis suggested economic viability in particular patient cohorts. ECT demonstrated improved tumour control and survival outcomes when combined with systemic immunotherapy. ECT is a safe, well-tolerated, and clinically effective treatment for stage III/IV metastatic melanoma, providing a valuable alternative for patients unsuitable for surgery or systemic chemotherapy. Further prospective RCTs are needed to establish its long-term role in melanoma care.