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Related Experiment Videos

Malignant melanoma. Practical considerations concerning prophylactic regional lymph node dissection.

A W Silberman

    Annals of Surgery
    |August 1, 1987
    PubMed
    Summary

    Prophylactic regional lymph node dissection (PRLND) for clinical Stage I malignant melanoma yielded 9.6% micrometastatic disease. This suggests PRLND offers limited therapeutic benefit for most patients, potentially serving better for staging.

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    Area of Science:

    • Oncology
    • Surgical Oncology
    • Dermatology

    Background:

    • Malignant melanoma staging is critical for treatment decisions.
    • Prophylactic regional lymph node dissection (PRLND) is a surgical option for staging and potential therapeutic benefit.
    • The yield of occult nodal disease in clinical Stage I melanoma requires further investigation.

    Purpose of the Study:

    • To evaluate the yield of micrometastatic disease in clinical Stage I malignant melanoma patients undergoing prophylactic regional lymph node dissection (PRLND).
    • To assess the potential therapeutic and prognostic value of PRLND in this patient cohort.

    Main Methods:

    • Seventy-three patients with clinical Stage I primary malignant melanoma underwent wide excision and 77 prophylactic regional lymph node dissections (PRLND).

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  • Preoperative evaluation, surgical procedures, and postoperative follow-up were managed by a single surgical oncologist.
  • Micrometastatic disease in regional lymph nodes was assessed.

    • Main Results:

    • A total of 7 patients (9.6% yield) were found to have micrometastatic disease in the regional lymph nodes.
    • In patients with Clark IV/V melanomas and Clark III melanomas ≥2.00 mm, the yield increased to 15.6%.
    • Optimistic survival data suggest only a modest benefit from PRLND, even with a 14.3% incidence of occult nodal disease.

    Conclusions:

    • The current yield of positive-node patients in clinical Stage I melanoma undergoing PRLND is low.
    • PRLND's therapeutic benefit is questionable unless a higher yield is achieved.
    • PRLND may be more justifiable for staging or prognostic information rather than direct therapeutic impact.