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James K. Wall, MD; Marilyn Florero, BS; Neil A. Accortt, PhD; Robert Allen, MD; Mohamed Kashani-Sabet, MD; Eugene Morita, MD; Stanley P. L. Leong, MD

Arch Surg. 2007;142:753-758.

Objective  To determine the impact of multiple lymphatic channels (MLCs) on outcome in melanoma.

Design  Retrospective cohort study.

Setting  Academic tertiary care center.

Patients  Of 1198 consecutive selective sentinel lymphadenectomies performed from 1995 to 2000 for primary invasive melanoma, 502 patients were identified with extremity or truncal melanoma that drained to a single nodal basin. Three cohorts were formed based on lymphatic channels (none, single, and multiple). Tumors with drainage to multiple nodal basins as well as all head and neck tumors were excluded.

Main Outcome Measures  Multiple variables, including patterns of lymphatic drainage, were analyzed for impact on disease-free and overall survival.

Results  Demographics were similar among groups, with a median follow-up of 5.6 years. Univariate analysis revealed MLCs as an independent risk factor for both disease-free (P = .04) and overall survival (P = .003). Multivariate analysis confirmed that tumor depth, sentinel lymph node status, and MLCs were risk factors for both disease-free and overall survival. Kaplan-Meier analysis showed worse survival in the MLCs group.

Conclusions  Our study reveals that MLCs are an independent risk factor for recurrence and mortality in melanoma. Multiple lymphatic channels may facilitate the process of metastasis.

Author Affiliations: Departments of Surgery (Drs Wall, Allen, and Leong, and Ms Florero), Dermatology (Dr Kashani-Sabet), and Radiology (Dr Morita), University of California, San Francisco; and Department of Biostatistics and Bioinformatics, Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham (Dr Accortt).

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