Axillary dissection in melanoma. Prognostic variables in node-positive patients

Area of Science:

• Oncology
• Surgical Pathology

Background:

• Malignant melanoma with positive regional lymph nodes presents a complex prognostic challenge.
• Identifying key prognostic factors is crucial for patient management and treatment planning.

Purpose of the Study:

• To evaluate the prognostic significance of 14 clinical and pathological variables in patients with malignant melanoma and positive regional lymph nodes.
• To identify independent determinants of survival for improved outcome prediction.

Main Methods:

• Retrospective review of 197 patients who underwent axillary dissection for malignant melanoma between 1974 and 1984.
• Univariate and multivariate analyses were performed to assess the significance of various clinical and pathological factors.

Main Results:

• Univariate analysis identified several significant factors including number/percentage of positive nodes, nodal status, nodal metastases, extranodal disease, clinical stage, and site.
• Multivariate analysis revealed that percentage of positive nodes, presence of extranodal disease, and lesion site (trunk vs. other) were independent predictors of survival.
• Specific patient subsets with distinct prognoses were identified based on these three variables.

Conclusions:

• The percentage of positive lymph nodes, extranodal disease, and primary lesion site are independent determinants of survival in malignant melanoma patients with positive nodes.
• A favorable prognosis is associated with <10% positive nodes, no extranodal disease, and non-trunk primary lesions.
• Extranodal disease and truncal primary lesions confer a poor prognosis, irrespective of the percentage of positive nodes.