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

Nicola Mozzillo,Corrado Caracò,Maurizio Montella,Gerardo Botti,Ugo Marone,Gianluca Di Monta,Anna Crispo,Paolo Antonio Ascierto

doi:10.1186/1477-7819-11-36

Abstract

BackgroundThe 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.MethodsBetween 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.ResultsThe 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).ConclusionsMetastasis 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.

Highlights

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
In the pre-sentinel lymph node biopsy era, many studies showed that the extent or aggressiveness of regional surgical therapy did not have a significant impact on melanoma-specific survival, with the extent of nodal involvement at the time of diagnosis being the only predictor of outcome [8,9,10]
The findings of the present study suggest that combined inguinal and pelvic lymph node dissection should be considered for patients with clinical evidence of groin nodal disease, as this approach achieved survival of 5 years for about one-third of patients in the presence of deep disease

Summary

Introduction

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. Many support the idea that iliacpelvic metastatic involvement indicates systemic disease. 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

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Results

Discussion

Conclusion