Patterns of Recurrence in Patients With Melanoma After Radical Lymph Node Dissection

Abstract

Hypothesis Previous interventions (excisional biopsy, incomplete dissection) in the regional basin that drain a melanoma site prior to definitive surgical procedures significantly increase the risk of melanoma recurrence in the surgical field. Design Retrospective analysis. Setting Tertiary care referral center. Patients One hundred forty-one consecutive patients who underwent radical lymph node dissection (RLND) either in the groin or the axilla owing to malignant melanoma were followed up for a median period of 41 months. Interventions All of the 141 patients received either elective or therapeutic RLND. Their medical records were analyzed for demographic data, disease history, previous treatments, recurrence patterns, and survival. Main Outcome Measures Patterns of first recurrence after RLND and survival. Results Radical lymph node dissection was performed on 148 lymph node basins (141 patients; 86 axillae and 62 groins). Nineteen patients (13%) received previous open interventions in the lymph node basin (tampering) other than radical dissection. Radical lymph node dissection was performed prophylactically in 38 basins (26%), for palpable disease in 75 (51%), and for a positive sentinel node in 35 (24%). There were 74 failures (52%) of RLND: 51 patients (70%) with systemic disease, 12 (16%) with recurrence in the surgical field, 9 (11%) with in-transit metastases, and 2 (3%) with local recurrence. On multivariate analysis, the only significant predictors of recurrence after RLND were Breslow thickness of greater than 4 mm ( P = .02), tampering ( P = .01), and lymph node capsular invasion ( P = .001). Tampering was the only independent prognosticator of failure in the surgical field, as tampering was noted in 10 (83%) of 12 patients with failure in the surgical field as compared with 6 (10%) of 62 patients with other types of first failures ( P P = .54). Failure in the surgical field was not detected in any of the patients who underwent sentinel lymph node biopsy. Conclusions Previous interventions (excisional biopsy, incomplete dissection) in the regional basin that drain a melanoma site prior to definitive surgical procedures significantly increase the risk of melanoma recurrence in the surgical field, and they should be avoided. Fine-needle aspiration and sentinel node biopsy, performed with strict surgical oncologic techniques, are safe with regard to failure in the surgical field.