Das inguinale Rezidiv nach therapeutischer Lymphadenektomie beim malignen Melanom

Abstract

In a retrospective study, 73 stage-II melanoma patients with 22 superficial and 51 deep groin dissections were observed over a maximum of 9 years of follow up (median 67.5 months). The 5-year survival rate of 29.8% was consistent with that yielded by comparable analyses of other investigators. However, the probability of recurrence in the node dissection field was as high as 35%. All groin recurrences occurred in the first 29 months after lymph node clearance (median 6 months). Patients with groin recurrence following lymph-node dissection had a poor prognosis (median survival 12 months). In a multifactorial analysis (Cox model), the only prognostic factor of probability of recurrence was the development of regional in-transit cutaneous metastases (p = 0.0028). Factors that did not affect the appearance of recurrent metastases in the node dissection field were: site of primary melanoma, tumor thickness, epidermal ulceration, degree of lymph node involvement (p = 0.2) age, sex, degree of surgery (superficial or deep groin dissection) and adjuvant chemotherapy. Because regional in-transit cutaneous metastases mostly occur synchronously with groin recurrence or later, they are a typical concomitant phenomenon rather than a prognostic factor of recurrence.

Standardized axillary lymphadenectomy improves local control but not survival in patients with palpable lymph node metastases of cutaneous malignant melanoma

“…Moreover, local recurrence in itself has a poor prognosis. We have previously demonstrated that the prognosis after recurrence in the dissected axilla is comparable with the prognosis of stage IV melanoma [18].…”

“…An improvement of local disease control by the application of surgical standard techniques might also have been expected in malignant melanoma but have not been previously demonstrated for patients with axillary lymph node metastases. In a previous paper [18], we had reported a local recurrence rate of 35 per cent after the excision of palpably enlarged axillary nodes. As a consequence, an operative procedure according to established standard techniques [3,11] was introduced in our clinic thereafter, and we now want to reassess whether the introduction of standardized lymphadenectomy has led to improved local control or survival rate.…”

“…Widely varying recurrence rates of up to 52% have been described after therapeutic node dissection [29,17,22,6,7,15,18]. Recurrent melanoma in a dissected lymph node basin is accompanied by significant morbidity.…”

Combined endoscopic and open inguinal dissection for malignant melanoma

“…Kissin et al [25], Singletary et al [3], Kretschmer et al [26], Harman et al [24], Mann and Coit et al [4], and Hughes and Thomas [1] observed more recurrences in the groin and pelvis after superficial dissection alone. Differences are found in general between a superficial (inguinal) and a combined inguinal and pelvic dissection.…”