Enhanced postoperative lymphatic staging of malignant melanoma by endoscopically assisted iliacoinguinal dissection

Radical lymphadenectomy for malignant melanoma continues to be controversial. In order to reduce morbidity but preserve prognostic informations, a minimally invasive technique for the iliac part of dissection was developed. We evaluated the practicability of this intervention under routine conditions as well as its prognostic impact. A total of 106 patients with tumor cell involvement of at least one inguinal lymph node underwent open inguinal dissection combined with a minimally invasive iliac dissection. Perioperative and postoperative data on morbidity, survival, and histopathological features of the primary and the dissected specimens were collected. Histopathological data were evaluated statistically for their prognostic relevance. Of the 106 patients, 38 showed evidence of additional metastases in the resected specimen, of which 11 cases were related to the iliac portion. Detection of lymph node metastases in the specimen was significantly correlated with a poorer prognosis, while out of all factors implicated, a new prognostic factor comprising iliac tumor involvement and primary tumor ulceration showed the strongest statistical correlation with prognosis. The median dissection time was 137 min, 58 min devoted to the iliac part. Complications necessitating reoperation (n = 7) related only to the inguinal wound area. Minimally invasive iliac lymph node dissection is ready for clinical routine. The additional information obtained by the iliac dissection-in particular, in combination with primary tumor ulceration-is of important prognostic relevance. Further development of this technique performing a completely minimally invasive ilioinguinal dissection may confer additional advantages.