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Multimodal Treatment

Linh Lam, MD; Edward Krementz, MD; Clifton McGinness, MD; Richard Godfrey, MD

Arch Surg. 2001;136:1054-1058.

Hypothesis  Treatment for melanoma that has metastasized to the supraclavicular nodes should be intensive and use a multimodality approach.

Design  Retrospective analysis of clinical records.

Setting  Six primary care centers, 2 of which were referral centers.

Patients  Eighteen patients diagnosed as having a rare pattern of advanced melanoma metastatic to the clavicular region.

Intervention  Combined radiotherapy, chemotherapy, and thorough surgical excision of the affected nodal basins.

Main Outcome Measure  Length of survival from time of diagnosis and treatment to time of follow-up.

Results  Median survival among the 18 patients was 28 months with a 22% survival rate at 5 years after diagnosis. Among patients who received radiotherapy to the clavicular node basin, mean length of survival was 88.7 months with a 50% 5-year survival rate compared with a mean length of survival of 33.8 months and an 8.3% 5-year survival rate in patients who did not receive radiotherapy (P<.001). Mean survival among patients who had supraclavicular node dissection was 45.8 months with a 23.1% survival rate at 5 years after diagnosis, compared with a mean survival of 52 months and a 20% 5-year survival rate among patients who did not receive therapeutic lymphadenectomy. Of the 11 patients who had therapeutic lymphadenectomy, 2 also received radiotherapy to the supraclavicular nodal basin and continued to be disease-free at 82 and 130 months. All long-term survivors had been treated with intra-arterial chemotherapy.

Conclusion  In a series of patients with malignant melanoma metastatic to the clavicular lymph nodes, multimodality treatment using radiotherapy, chemotherapy, and thorough surgical excision of affected nodal basins provided an appreciable 5-year survival rate.

From the Departments of Surgery, Tulane University Medical Center (Dr Krementz) and Memorial Medical Center (Dr McGinness), New Orleans, La; and Kaiser Permanente Medical Center, Oakland, Calif (Drs Lam and Godfrey).

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