En bloc resection of the primary melanoma with the regional lymph node drainage basin as a method of controlling disease within the area was used in 281 patients with stage I or II melanoma arising on the extremities (proximal to wrist or ankle) or on the trunk from 1954 through 1964. The en bloc operation was performed in 212 patients with a five-year cure of 73.5% (156 of 212). Seventy-six percent had histologically negative nodes. Only 2% developed regional recurrence.
Sixty-nine patients had a discontinuous dissection. The five-year cure was comparable: 68% (47 of 69). The incidence of histologically negative nodes was similar (77%), but the regional recurrence rate was 14%. This difference is significant at p <.01. The incontinuity or en bloc procedure appears highly effective for its designed purpose.
Fortner JG, Schottenfeld D, Maclean BJ. En Bloc Resection of Primary Melanoma With Regional Lymph Node Dissection. Arch Surg. 1975;110(5):674–676. doi:10.1001/archsurg.1975.01360110220038