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March 1994

Melanoma Recurrence in a Previously Dissected Lymph Node Basin

Author Affiliations

From the Cancer Center, University of Illinois at Chicago, and Humana Hospital-Michael Reese Cancer Center, Chicago.

Arch Surg. 1994;129(3):252-255. doi:10.1001/archsurg.1994.01420270028006

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.(Arch Surg. 1994;129:252-255)