Elective lymph node dissection in melanoma: still a controversial issue

Clinically not suspected regional lymph node areas are usually left in situ in patients with a primary melanoma with a Breslow thickness of 1.5 mm or less. In patients with melanomas more than 4 mm thick, elective dissection has also little or no effect on survival, because the frequent haematogenous micrometastases determine the prognosis. There is no agreement on the policy concerning elective lymph node dissection in patients with melanoma thicknesses between 1.5 and 4 mm. Some favour a wait-and-see policy, basing their arguments on the results of a WHO prospective trial. Others recommend elective node dissections in these patients, based on the results from a number of large, well-analysed retrospective studies and because of objections against the WHO trial. More prospective comparative studies and research aiming at direct clinical detection of microscopical (occult) lymph node metastases will have to be carried out before a consensus may be reached on the benefit of intervention in this category of patients.