[Results of elective lymph node excision in melanoma of the trunk]

In our department, between 1979 and 1994, 254 patients, thereof 171 male, 83 female with the average age of 48.2 years underwent surgery because of stage 1 (T2) to stage 3 melanoma that was located on the trunk. Our retrospective analysis was based on those 211 patients who had been followed up by the department of dermatology in our medical center. It was the aim of our study-apart from determining the long-term-prognosis-to find out the number of patients in whom a curative resection could be only achieved by elective lymph node dissection. The 5-year survival rate amounted to 79% for all patients. For patients suffering from stage 1-disease (T2) it was 93%, for those with stage 2-disease 89%, and in case of stage 3-disease 49% respectively. After ELND had been performed, no lymph node metastases were found in patients (0/22) suffering from a T2-tumor. In case of T3-tumors, in 13% (11/82) and in case of T4-tumors in 30% (13/43) lymph node metastases were found. However, only 5 out of 11 patients, with the established diagnosis of a T3-tumor in whom positive lymph-nodes had been found by ELND, and merely 6 out of the 13 patients with a T4-tumor, are still alive after a mean follow-up period of 74 months. We conclude that ELND is not indicated in patients with T2-melanoma. In case of T3- and T4-melanoma, some doubts exist whether patients really benefit from this surgical procedure. Randomized prospective studies are necessary to clarify the importance of elective lymph node dissection.