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Role of elective lymph node dissection in melanoma
1Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Seminars in Surgical Oncology
|May 20, 1998
Summary
Elective lymph node dissection (ELND) is not routinely recommended for most melanoma patients with negative lymph nodes. However, it may benefit specific patient subgroups, with sentinel lymph node biopsy offering an alternative.
Area of Science:
- Oncology
- Dermatology
- Surgical Oncology
Background:
- Regional lymph nodes are the most common site for melanoma metastasis.
- Surgical excision of involved nodes is the primary treatment for melanoma.
- Management of clinically negative regional lymph nodes remains a debated topic.
Purpose of the Study:
- To evaluate the efficacy of elective lymph node dissection (ELND) in clinically negative regional lymph nodes for malignant melanoma.
- To identify patient subgroups who may benefit from ELND.
- To compare ELND with sentinel lymph node biopsy (SLNB) as management strategies.
Main Methods:
- Review of retrospective studies and four prospective randomized clinical trials.
- Analysis of outcomes based on patient age, melanoma thickness, and ulceration.
- Consideration of lymphatic mapping with sentinel lymph node biopsy.
Main Results:
- Routine ELND is not beneficial for the majority of melanoma patients with clinically negative nodes.
- ELND may improve outcomes in specific subgroups: patients younger than 60 with 1-2 mm thick melanomas, with or without ulceration.
- Sentinel lymph node biopsy (SLNB) has emerged as a viable alternative to ELND.
Conclusions:
- Routine ELND is not recommended for most patients with clinically negative regional lymph nodes in malignant melanoma.
- ELND may be considered for select high-risk subgroups in the absence of SLNB.
- SLNB provides an alternative approach for staging regional lymph nodes in melanoma.