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Melanoma of the clavicular region: multimodal treatment
L Lam1, E Krementz, C McGinness
1Department of Surgery, Kaiser Permanente Medical Center, 280 W MacArthur Blvd, Oakland, CA 94611-5693, USA.
Hypothesis:
Treatment for melanoma that has metastasized to the supraclavicular nodes should be intensive and use a multimodality approach.
Design:
Retrospective analysis of clinical records.
Setting:
Six primary care centers, 2 of which were referral centers.
Patients:
Eighteen patients diagnosed as having a rare pattern of advanced melanoma metastatic to the clavicular region.
Intervention:
Combined radiotherapy, chemotherapy, and thorough surgical excision of the affected nodal basins.
Main Outcome Measure:
Length of survival from time of diagnosis and treatment to time of follow-up.
Results:
Median survival among the 18 patients was 28 months with a 22% survival rate at 5 years after diagnosis. Among patients who received radiotherapy to the clavicular node basin, mean length of survival was 88.7 months with a 50% 5-year survival rate compared with a mean length of survival of 33.8 months and an 8.3% 5-year survival rate in patients who did not receive radiotherapy (P<.001). Mean survival among patients who had supraclavicular node dissection was 45.8 months with a 23.1% survival rate at 5 years after diagnosis, compared with a mean survival of 52 months and a 20% 5-year survival rate among patients who did not receive therapeutic lymphadenectomy. Of the 11 patients who had therapeutic lymphadenectomy, 2 also received radiotherapy to the supraclavicular nodal basin and continued to be disease-free at 82 and 130 months. All long-term survivors had been treated with intra-arterial chemotherapy.
Conclusion:
In a series of patients with malignant melanoma metastatic to the clavicular lymph nodes, multimodality treatment using radiotherapy, chemotherapy, and thorough surgical excision of affected nodal basins provided an appreciable 5-year survival rate.