ABSTRACT
The role of elective lymph node dissection (ELND) in primary malignant melanoma is controversial. Our purpose was to evaluate the benefit of ELND regarding survival and disease-free survival in malignant melanoma of the trunk and extremities. By matched-pair analysis, 375 patients treated by wide local excision (WLE) plus ELND were compared to 375 patients treated by WLE only. There was no difference in survival between the two treatment groups; however, the disease-free interval was significantly higher in the collective treated by WLE plus ELND (P < 0.05). Increased survival rates were noted for intermediate tumor thickness of 1.51-4.0 mm for the WLE+ELND group although the difference was not significant (P = 0.14), and disease-free survival was significantly improved in this group (P < 0.001). ELND elicited a higher benefit in male patients with intermediate thickness melanoma. Our results confirm the findings of several studies that ELND improves the outcome after primary treatment of malignant melanoma of intermediate tumor thickness.
Subject(s)
Lymph Node Excision , Melanoma/surgery , Skin Neoplasms/surgery , Adult , Female , Follow-Up Studies , Humans , Lymphatic Metastasis , Male , Matched-Pair Analysis , Melanoma/mortality , Melanoma/pathology , Middle Aged , Neoplasm Recurrence, Local/mortality , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/surgery , Neoplasm Staging , Skin Neoplasms/mortality , Skin Neoplasms/pathology , Survival RateABSTRACT
The role of elective lymph node dissection (ELND) in primary malignant melanoma is still controversial. Our purpose in this study was to evaluate the benefit from ELND on survival and disease-free survival in malignant melanoma of the trunk and extremities. We performed a matched-pair analysis on 750 patients. There was no significant benefit from wide local excision (WLE) plus ELND compared with WLE in the total group. Increased survival rates were noted for tumour thicknesses of 1.51-4.0 mm for the WLE+ELND group, as shown by 10-year survival rates of 73.1% vs 60.3% (p = 0.14). A significant benefit of ELND was detected for malignant melanoma of the trunk (p < 0.05). Disease-free survival rates were significantly higher in the collective treated by additional ELND for all tumour thicknesses (p < 0.05) and even more in intermediate tumour thicknesses of 1.51-4.0 mm (p < 0.001). Our data give further support that ELND may be valuable in improving the prognosis in case of malignant melanoma of intermediate Breslow thickness.
Subject(s)
Lymph Node Excision , Melanoma/surgery , Adult , Disease-Free Survival , Extremities , Female , Humans , Male , Matched-Pair Analysis , Middle Aged , Retrospective Studies , Survival Analysis , Survival RateABSTRACT
The role of elective lymph node dissection (ELND) in clinical stage I malignant melanoma continues to be controversial. We present a matched pair analysis of 375 patients treated in the Department of Dermatology in Kassel between 1979 and 1991 by wide local excision (WLE) plus ELND. Multivariate analysis revealed tumor thickness, level of invasion, age, sex, and localization as independent prognostic factors, and 375 patients treated by WLE alone were matched as controls to the patients treated by ELND and WLE. There was no significant benefit from WLE plus ELND compared to WLE alone in the total group as shown by the 5-year survival rates (87.3% versus 86.4%) and 10-year survival rates (80.1% versus 77.82%). Increased survival rates were noted for tumor thicknesses 1.51-4.0 mm for the WLE plus ELND group, as shown by the 10-year survival rates of 73.1% versus 60.3%. However, these data were not significant (p = 0.14). Disease-free survival rates were significantly higher in the group treated by additional ELND for all tumor thicknesses (p < 0.05) and even more in intermediate tumor thicknesses of 1.51-4.0 mm (p < 0.001). A significant benefit of elective lymph node dissection was detected for malignant melanoma of the trunk (all tumor thicknesses), as shown by the 5-year survival rates of 92.0% versus 79.7% and 10-year survival rates of 80.4% versus 45.16% (p < 0.05). Malignant melanoma of the extremities revealed no significant differences in survival rates. We conclude that there is a certain benefit from ELND in clinical stage I malignant melanoma for tumor thicknesses of 1.51-4.00 mm. Especially in malignant melanoma of the trunk, WLE plus ELND was more beneficious than WLE alone.
