Adjuvant radiation therapy for high-risk nodal metastases from cutaneous melanoma

The role of radiotherapy for nodal metastases from malignant melanoma is controversial. In patients with features that indicate high risk of recurrence of nodal disease, adjuvant irradiation lowers recurrence rates. High-risk features include extranodal spread of melanoma, more than two positive lymph nodes, large nodal size, or recurrent disease in previously dissected nodal basin. Data from randomised trials that confirm a benefit of adjuvant radiotherapy in patients with nodal disease at high risk of recurrence are unavailable. However, the use of adjuvant radiotherapy for high-risk nodal disease is increasingly widespread. Recurrence rates and risk of complications differ with anatomic location of the nodal basin involved, and treatment decisions should be made accordingly. Whether to use hypofractionated radiotherapy or conventional fractionation regimens for adjuvant irradiation to nodal basins is also a matter of debate. Hypofractionation is the accepted approach when radiotherapy is recommended. Technical issues have to be considered when hypofractionated regimens are given because survival might be long and the potential for normal tissue toxicity is high. Overall survival remains poor for patients with macroscopic nodal metastases from malignant melanoma. Until advances in systemic treatment are available, regional nodal control is an important endpoint for patients with this disease.