Melanoma recurrence in a previously dissected lymph node basin
M. A. Warso and T. K. Das Gupta
Cancer Center, University of Illinois at Chicago.
OBJECTIVES: To retrospectively assess whether completeness of node
dissection has any bearing on regional control in cutaneous melanoma and to
examine the efficacy of a subsequent dissection in patients with isolated
nodal recurrence. DESIGN: Case series, 18-month minimum follow-up. SETTING:
Academic surgical practice. STUDY PARTICIPANTS: Patients with cutaneous
melanoma who had undergone a regional node dissection and subsequently
developed recurrence in the same nodal basin in which a lymphadenectomy had
been performed with no evidence of distant metastases. Of 1030 instances of
regional node dissection, 28 met these criteria. MAIN OUTCOME MEASURES:
Nodal recurrence in the previously dissected lymph node basin as the only
site of recurrence and survival following a subsequent lymph node
dissection. RESULTS: The 28 instances of isolated nodal recurrence
represent a regional failure rate of 2.7%. In those cases where the first
dissection was performed within our division, the rate is 0.8%. Recurrence
for cervical, axillary, or inguinal sites was similar. In 71% of the cases,
more than one node was positive at the time of recurrence. Four patients
have shown disease-free survival greater than 3 years following a
subsequent lymphadenectomy. CONCLUSION: Node dissection is a therapeutic
procedure and, therefore, must consist of complete lymphadenectomy with
meticulous attention to surgical detail. Approached in this fashion, only a
small subgroup of patients will show recurrence in a previously dissected
nodal basin, a few of whom can be salvaged by a second dissection.
