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Is a level III dissection necessary for a positive sentinel lymph node in melanoma?
Jukes P Namm1, Alfred E Chang, Vincent M Cimmino
1Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA.
Journal of Surgical Oncology
|September 2, 2011
Summary
For melanoma patients with a positive sentinel lymph node (SLN), a level I/II axillary lymph node dissection (ALND) shows low recurrence and complication rates. This suggests that a level III dissection may not be necessary, potentially improving patient outcomes.
Area of Science:
- Surgical Oncology
- Melanoma Research
- Clinical Trials
Background:
- The extent of axillary lymph node dissection (ALND) for melanoma patients with a positive sentinel lymph node (SLN) is debated.
- Specifically, the necessity of a level III dissection is questioned.
Purpose of the Study:
- To evaluate the recurrence and complication rates of level I/II ALND in melanoma patients with a positive SLN.
- To compare these rates with existing literature on ALND including level III dissection.
Main Methods:
- A prospective database was queried for patients with a positive SLN undergoing level I/II ALND.
- Recurrence and complication rates were analyzed and compared to published data.
Main Results:
- 270 patients underwent 285 level I/II ALNDs for a positive SLN between 1998 and 2008.
- The study observed a 5% regional recurrence rate and an 11% complication rate (primarily cellulitis).
- 13% of patients had positive non-SLN, with a median of 18.7 nodes removed per ALND.
Conclusions:
- Level I/II ALND for a positive SLN demonstrated complication and regional recurrence rates comparable to or lower than studies including level III dissection.
- These findings suggest that a level III dissection may offer minimal additional benefit in this patient population.
