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Selective use of wide excision with elective lymph node dissection for malignant melanoma
Pathology Annual
|January 1, 1985
Summary
Histologically positive lymph nodes were found in 0-42% of patients with clinically negative nodes, varying by lesion depth. Metastasis size significantly impacts disease-free survival, highlighting the importance of early detection in cancer management.
Area of Science:
- Oncology
- Surgical Pathology
Background:
- Clinically negative regional lymph nodes do not always indicate the absence of metastasis.
- Accurate staging is crucial for effective cancer treatment and prognosis.
Purpose of the Study:
- To determine the incidence of occult lymph node metastases in patients with clinically negative nodes.
- To evaluate the correlation between lymph node metastasis size and disease-free survival.
Main Methods:
- Analysis of 180 patients with clinically negative regional lymph nodes.
- Elective lymph node dissection performed on 110 patients.
- Histopathological examination of lymph nodes to identify metastases and assess their size.
Main Results:
- Histologically positive lymph nodes were found in 0%, 17%, and 42% of patients with thin, intermediate, and deeply invasive lesions, respectively.
- Micro-metastases (≤2 mm) were more common in intermediate thickness lesions (75%) compared to deeply invasive ones (38%).
- Two-year disease-free survival rates were 70% for micro-metastases versus 24% for macro-metastases.
Conclusions:
- Occult lymph node metastases are present in a significant proportion of patients with clinically negative nodes, particularly with thicker lesions.
- Lymph node metastasis size is a critical prognostic factor, with micro-metastases associated with better outcomes.
- Early detection and accurate assessment of lymph node involvement are vital for improving therapeutic success in cancer patients.