The Management of Cervical Lymph Nodes in Patients with Cutaneous Melanoma

Abstract

The aim of this study was to review the management of cervical lymph nodes in patients with cutaneous melanoma and to analyze factors influencing prognosis. This was a retrospective cohort study of patients who had cervical node surgery at the Sydney Melanoma Unit from 1990 to 2004. Of 716 patients who met the study criteria, 339 had a sentinel node biopsy (SNB) and 396 had a neck dissection. Locoregional recurrence occurred in 27.6% of those undergoing therapeutic neck dissection and 60% eventually developed distant metastases. Radiotherapy was given as adjuvant treatment in 110 of the patients who had a therapeutic neck dissection (41%), but this was not associated with improved regional control (p=.322). Multivariate analysis showed that nodal positivity (p<.001) and primary tumor ulceration (p=<.027) were the most important predictors of locoregional recurrence and that primary tumor Breslow thickness (p=.009) and node positivity (p=.046) were the most important factors predicting survival. SNB-positive patients who underwent immediate completion lymphadenectomy had a 5-year survival advantage over those who had a therapeutic neck dissection for macroscopic disease (54% vs 47%, p=.028). Nodal status was the most important factor predicting disease-free and overall survival in patients with melanoma of the head and neck. Adjuvant radiotherapy was not associated with better locoregional control in the non-randomized cohorts of patients in this study.