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Prognosis and Treatment

Shlomo Schneebaum, MD; Henry A. Briele, MD; Michael J. Walker, MD; John Greager, MD; Donald K. Wood, MD; Salve G. Ronan, MD; Minu K. Patel, MS; Tapas K. Das Gupta, MD, PhD

Arch Surg. 1987;122(6):707-711.

Abstract
• Among proponents of elective lymph node dissection (ELND) for clinical stage I melanoma, controversy exists as to whether there is an upper limit of tumor thickness beyond which ELND should not be considered. We reviewed 169 patients with clinical stage I and II melanoma that was greater than or equal to 3.0 mm thick and who were treated at the University of Illinois Hospital, Chicago. Of 139 patients with clinical stage I disease, 117 underwent ELND. Five- and ten-year survival rates were 55.7% and 48.9%, respectively. Multifactorial analysis demonstrated that anatomical location, level, pathologic stage, and ulceration were the best predictors of survival. Thickness did not emerge as a significant variable. Our findings do not support basing treatment decisions, eg, ELND in this group of patients, solely on the thickness of the primary tumor. We continue to recommend ELND in patients with either intermediate or thick melanomas.

(Arch Surg 1987;122:707-711)

Author Affiliations
From the Division of Surgical Oncology, Departments of Surgery (Drs Schneebaum, Briele, Walker, Greager, Wood, and Das Gupta) and Pathology (Dr Ronan), and the Section of Biometry, Research Resources Center (Mr Patel), University of Illinois at Chicago and Cook County Hospital; the Hektoen Institute for Medical Research (Drs Schneebaum, Briele, Walker, Greager, Wood, and Das Gupta); and the West Side Veterans Administration Hospital (Drs Schneebaum, Briele, Walker, Greager, Wood, and Das Gupta), Chicago.

Footnotes
Accepted for publication April 17, 1987.

Read before the 94th Annual Meeting of the Western Surgical Association, Dearborn, Mich, Nov 17, 1986.

Reprint requests to Division of Surgical Oncology, Department of Surgery, University of Illinois at Chicago, 840 S Wood St, Chicago, IL 60612 (Dr Briele).

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