Superficial and deep lymph node dissection for stage III cutaneous melanoma: clinical outcome and prognostic factors

World Journal of Surgical Oncology, Feb 2013

Background The aims of this retrospective analysis were to evaluate the effect of combined superficial and deep groin dissection on disease-free and melanoma-specific survival, and to identify the most important factors for predicting the involvement of deep nodes according to clinically or microscopically detected nodal metastases. Methods Between January 1996 and December 2005, 133 consecutive patients with groin lymph node metastases underwent superficial and deep dissection at the National Cancer Institute, Naples. Lymph node involvement was clinically evident in 84 patients and detected by sentinel node biopsy in 49 cases. Results The 5-year disease-free survival was significantly better for patients with superficial lymph node metastases than for patients with involvement of both superficial and deep lymph nodes (34.9% vs. 19.0%; P = 0.001). The 5-year melanoma-specific survival was also significantly better for patients with superficial node metastases only (55.6% vs. 33.3%; P = 0.001). Conclusions Metastasis in the deep nodes is the strongest predictor of both disease-free and melanoma-specific survival. Deep groin dissection should be considered for all patients with groin clinical nodal involvement, but might be spared in patients with a positive sentinel node. Prospective studies will clarify the issue further.

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Superficial and deep lymph node dissection for stage III cutaneous melanoma: clinical outcome and prognostic factors

World Journal of Surgical Oncology Superficial and deep lymph node dissection for stage III cutaneous melanoma: clinical outcome and prognostic factors Nicola Mozzillo 2 Corrado Carac 0 Ugo Marone 0 Gianluca Di Monta 0 Anna Crispo Gerardo Botti Maurizio Montella Paolo Antonio Ascierto 1 0 Division of Melanoma and Skin Cancer , Via Mariano Semmola, Naples 80131 , Italy 1 Division of Oncology , Via Mariano Semmola 2 Department of Melanoma, Sarcoma and Skin Cancer , Via Mariano Semmola, Naples 80131 , Italy Background: The aims of this retrospective analysis were to evaluate the effect of combined superficial and deep groin dissection on disease-free and melanoma-specific survival, and to identify the most important factors for predicting the involvement of deep nodes according to clinically or microscopically detected nodal metastases. Methods: Between January 1996 and December 2005, 133 consecutive patients with groin lymph node metastases underwent superficial and deep dissection at the National Cancer Institute, Naples. Lymph node involvement was clinically evident in 84 patients and detected by sentinel node biopsy in 49 cases. Results: The 5-year disease-free survival was significantly better for patients with superficial lymph node metastases than for patients with involvement of both superficial and deep lymph nodes (34.9% vs. 19.0%; P = 0.001). The 5-year melanoma-specific survival was also significantly better for patients with superficial node metastases only (55.6% vs. 33.3%; P = 0.001). Conclusions: Metastasis in the deep nodes is the strongest predictor of both disease-free and melanoma-specific survival. Deep groin dissection should be considered for all patients with groin clinical nodal involvement, but might be spared in patients with a positive sentinel node. Prospective studies will clarify the issue further. Cutaneous melanoma; Sentinel biopsy; Lymph node metastases - Background Lymph node metastasis is a powerful predictor of recurrence and death in patients with cutaneous melanoma. Metastasis to regional lymph nodes develops during the course of the disease in approximately 30% of patients with cutaneous melanoma [1,2]. Radical lymph node dissection, defined as the removal of all lymph node levels of the involved basin, is recognized as the treatment of choice after histological or cytological evidence of lymph node involvement. For metastasis to inguinal lymph nodes, disagreement exists about the extent of surgical dissection and whether an iliac-pelvic lymphadenectomy is always mandatory. Many support the idea that iliacpelvic metastatic involvement indicates systemic disease and that an aggressive surgical approach will not improve melanoma-specific survival [3,4]. Data on the long-term follow-up of patients with stage III melanoma (regional lymph node metastases) have demonstrated that about 20% of patients with involvement of deep (iliac and obturator) nodes were alive at 20 years, which suggests that surgical excision of nodal metastases is more than a staging or palliative procedure [5,6]. The aims of this retrospective analysis were to determine disease-free and melanoma-specific survival in the case of combined superficial and deep groin dissection, to identify the most important factors for predicting the involvement of deep nodes, and to describe differences in melanoma-specific survival and disease-free survival according to clinically or microscopically detected nodal metastases. Methods Between January 1996 and December 2005, 520 patients underwent surgical lymph node dissection for metastases at the National Cancer Institute, Naples. Of these patients, 315 (60.6%) had metastases in lymph node basins other than the groin and 205 (39.4%) had inguinal lymph node metastases. Among the patients with inguinal lymph node metastases, combined superficial and deep groin dissection was considered the treatment of choice in patients with either a positive sentinel node or clinical groin disease. Superficial groin dissection only was limited to 72 patients for a variety of clinical reasons (such as anesthetic risk, age or life expectancy) and these cases were excluded from the present analysis. The main clinical characteristics of the 133 patients included in the study are summarized in Table 1. The mean age was 50 years (range 21 to 83 years). The primary melanoma was located in the lower extremity in most patients (70.7%). The mean Breslow thickness of the primary melanoma was 4.0 mm and 77 melanomas (69.3%) were classified as T3 to T4. In 22 patients, histological findings of the primary melanoma were not available. In 84 patients (63.1%) (16 of whom had false negative sentinel nodes), adenopathy localized to the superficial groin area was clinically detected, with cytological confirmation of metastatic involvement, and in 49 patients (36.9%), micrometastatic disease was identified with sentinel node biopsy. Disease was staged in all patients with the use of computed tomog (...truncated)


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Nicola Mozzillo, Corrado Caracò, Ugo Marone, Gianluca Di Monta, Anna Crispo, Gerardo Botti, Maurizio Montella, Paolo Ascierto. Superficial and deep lymph node dissection for stage III cutaneous melanoma: clinical outcome and prognostic factors, World Journal of Surgical Oncology, 2013, pp. 36, 11, DOI: 10.1186/1477-7819-11-36