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Therapeutic node dissections in malignant melanoma
1Department of Surgery, State University of New York at Buffalo, Millard Fillmore Health System, 14209, USA.
Background:
Therapeutic lymphadenectomies involve the dissection and removal of clinically enlarged, histologically positive nodes at the regional nodal basin, in the absence of detectable distant disease.
Methods:
The literature dealing with therapeutic lymphadenectomies in malignant melanoma was reviewed.
Results:
The rate of wound complications varies with the particular nodal basin. The 5-year survival varies from 19% to 38%, with an average of 26%. Survival is affected primarily by the number of histologically positive nodes and extracapsular spread, and secondarily by the extent of disease at the various levels of the nodal basin, fixation of the nodes, and, probably, the preceding disease-free interval. Prognostic parameters of the primary lesion, e.g., thickness, ulceration, and location, also may have an effect on survival. The rate of local recurrence at the nodal basin after lymphadenectomy has varied from 0.8% to 52%. Adjuvant therapy with interferon alfa-2b has improved the 5-year disease-free survival from 26% to 37%.
Conclusions:
Therapeutic node dissections in melanoma provide an appreciable 5-year survival rate, which is further augmented by adjuvant therapy. Many series report a significant rate of local recurrence at the nodal basin following therapeutic dissection. Complete lymphadenectomy reduces the rate of local failure with its attendant morbidity.
Insights
Therapeutic lymphadenectomies for melanoma offer a survival benefit, with adjuvant therapy further improving outcomes. Complete dissection is crucial for reducing local recurrence rates and associated morbidity.
Area of Science:
- Oncology
- Surgical Oncology
- Dermatology
Background:
- Therapeutic lymphadenectomies involve removing enlarged, positive lymph nodes in melanoma patients without distant disease.
- This procedure targets regional nodal basins to manage cancer spread.
Purpose of the Study:
- To review the literature on therapeutic lymphadenectomies in malignant melanoma.
- To analyze survival rates, prognostic factors, and recurrence rates associated with this procedure.
Main Methods:
- A comprehensive literature review was conducted on therapeutic lymphadenectomies in malignant melanoma.
- Data on survival, complications, recurrence, and adjuvant therapies were synthesized.
Main Results:
- Five-year survival rates range from 19% to 38% (average 26%), influenced by node positivity and extracapsular spread.
- Local recurrence rates vary widely (0.8%–52%), but complete lymphadenectomy can reduce failure.
- Adjuvant interferon alfa-2b improved 5-year disease-free survival from 26% to 37%.
Conclusions:
- Therapeutic lymphadenectomies provide a significant survival rate for melanoma patients.
- Complete lymphadenectomy is essential for minimizing local recurrence and morbidity.
- Adjuvant therapies can further enhance survival outcomes in melanoma management.