[Preventive lymph node excision in the treatment concept of melanoma of the extremities]

Since 1979, our treatment protocol for extremity melanoma includes regional lymph node dissection, wide tumor excision and hyperthermic limb perfusion. We report on the results of a follow-up of the 451 patients treated in the first decade. 58.5% of patients presented with a primary tumor, additional 7.4% with a local recurrence or satellite metastases without evidence for further tumor extension. Regional lymph node metastases were not found below a tumor thickness of 1.5 mm; then micrometastases occurred in 5-10%, macrometastases at over 1.9 mm in up to over 15% of tissue specimens. 5-year survival was 90% if nodes were negative, 66% if there were micrometastases and 30% for further lymph node metastases. We conclude that patients may benefit from prophylactic dissection of regional lymph nodes if careful selection according to pathohistological and clinical criteria is performed.