Malignant melanoma. Practical considerations concerning prophylactic regional lymph node dissection

Seventy-three patients had 77 prophylactic regional lymph node dissections (PRLND) in addition to wide excision of the primary lesion for clinical Stage I primary malignant melanoma. The preoperative evaluation, surgical procedure, and postoperative follow-up were performed by one surgical oncologist. Seven patients had micrometastatic disease in the regional nodes for a yield of 9.6%. Considering only patients with Clark IV and V melanomas, and Clark III melanomas greater than or equal to 2.00 mm, the yield was 15.6%. The most optimistic, published survival statistics demonstrate a 25% 5-year survival advantage for patients who have PRLND with an incidence of occult nodal disease of 14.3%; thus, even the most optimistic data would predict that only a modest number of patients would actually benefit from surgery. It is difficult to justify PRLND for its therapeutic benefit unless a higher yield of positive-node patients is obtained or the surgical indication is for staging or prognostic information.