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Can elective lymph node dissection decrease the frequency and mortality rate of late melanoma recurrences?

P Shen1, J M Guenther, L A Wanek

  • 1Department of Surgical Oncology and the Roy E Coats Research Laboratories of the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California, USA.

Annals of Surgical Oncology
|April 13, 2000
PubMed
Summary
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Melanoma can recur more than 10 years after treatment. Elective lymph node dissection (ELND) significantly reduces late nodal recurrence and improves survival compared to wide local excision alone for cutaneous melanoma.

Area of Science:

  • Oncology
  • Surgical Oncology
  • Dermatology

Background:

  • Cutaneous melanoma recurrence after 10 years is rare but can be fatal.
  • This study investigates factors influencing late melanoma recurrence after a 10-year disease-free interval (DFI).

Purpose of the Study:

  • To identify clinicopathological factors associated with melanoma recurrence beyond 10 years post-treatment.
  • To evaluate the impact of initial surgical treatment on late recurrence patterns and outcomes.

Main Methods:

  • Retrospective analysis of 1907 melanoma patients with ≥10-year DFI.
  • Identified 217 patients (11%) with late recurrences.
  • Analyzed recurrence sites, timing, and association with initial treatment (wide local excision vs. wide local excision + elective lymph node dissection (ELND)).

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Main Results:

  • Late recurrence occurred in 11% of patients, with nodal recurrence being common (47%).
  • Initial treatment type significantly impacted late nodal recurrence (P = .0001).
  • Patients undergoing wide local excision + ELND had significantly lower nodal recurrence rates (20%) vs. wide local excision alone (53%) and improved survival.

Conclusions:

  • Wide local excision without ELND increases the risk of late nodal recurrence and decreases long-term survival in melanoma patients.
  • Selective ELND, guided by sentinel lymph node biopsy, can identify occult nodal metastases, reducing morbidity while improving outcomes.