Results of Ilioinguinal Dissection for Stage II Melanoma

Finck, Sanford J.; Giuliano, Armando E.; Mann, Barry D.; Morton, Donald L.

doi:10.1097/00000658-198208000-00010

Cited by 56 publications

(23 citation statements)

References 4 publications

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“…The incidence of iliac node tumor positivity is also directly related to the number of pathologically tumorpositive inguinal nodes. Finck et al 7 have shown that the incidence of tumor-positive iliac nodes increases from 14% when 1 inguinal node is pathologically tumor positive to 50% when 4 or more nodes are involved. Other investigators 32 have shown a 100% incidence of iliac node tumor positivity when 3 or more inguinal nodes contain metastatic disease.…”

Section: 421mentioning

confidence: 99%

See 1 more Smart Citation

Surgical Management of the Groin Lymph Nodes in Melanoma in the Era of Sentinel Lymph Node Dissection

Essner

Scheri²,

Kavanagh³

et al. 2006

Arch Surg

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Intraoperative lymphatic mapping and sentinel lymphadenectomy (LM/SL) has become an increasingly popular surgical technique for staging the regional lymph nodes in early-stage melanoma. The technique of LM/SL has potentially great advantage for the groin, where the morbidity of superficial groin dissection or iliac dissection can be high. The surgical management of these basins is unknown for patients with tumor-positive sentinel lymph nodes (SNs).Design: Cohort of successive patients undergoing LM/SL over 18 years. Those patients found to have tumorpositive SNs underwent sentinel complete lymph node dissection. Postoperatively, patients were followed up on a routine basis with serial examinations and chest radiography. The median follow-up was 50 months.Setting: Tertiary cancer center. Patients:The technique of LM/SL was performed for 431 consecutive patients. Sentinal lymph nodes were identified in each case. Patients with tumor-positive SNs underwent sentinel complete lymph node dissection.Intervention: Cutaneous lymphoscintigraphy and blue dye with or without use of the gamma probe-directed LM/ SL. Sentinel lymph nodes were examined by hematoxylineosin staining and immunohistochemistry staining with HMB-45andS100protein.Onlypatientswithtumor-positive SNs had sentinel complete lymph node dissection.Main Outcome Measure: Computer-assisted database with statistical analyses using log-rank tests and Cox regression models.Results: Of the 431 patients, 264 (61%) were women and the median age was 50 years (age range, 15-89 years). A majority (86%) of the primary tumors were on the lower extremities, 54% were of Clark level IV or V, and there was a mean ± SD thickness of 1.89 ± 1.59 mm (range, 0.30-14.00 mm). Ninety-three patients (21%) were found to have tumor-positive SNs. After LM/SL and sentinel complete lymph node dissection, 62 patients (67%) were found to have a single tumor-positive lymph node, 25 (27%) had 2 tumor-positive lymph nodes, and 6 (6%) had 3 or more tumor-positive lymph nodes. Only 12 patients (4%) with tumor-negative SNs have had recurrence in the dissected basin. The 5-year overall survival was significantly better for patients with tumor-negative lymph nodes (mean±SD 5-year overall survival, 94%±5%) than for patients with tumor-positive lymph nodes (mean±SD 5-year overall survival, 75%±4%) (PϽ.01). The tumor status of the Cloquet lymph node was predictive of the tumor status of the iliac lymph nodes. Multivariate analyses with a Cox regression model identified tumor-positive SN (P=.001), primary tumor thickness (P=.03), and ulceration (P=.001) as being predictive of survival. Sex, age, Clark level, and primary site were not significant (PϾ.05). Conclusions:Our results demonstrate the prognostic significance of LM/SL for early-stage melanoma draining to the groin basin. The accuracy of LM/SL measured by the rare recurrences suggests that this surgical procedure should become standard for patients with early-stage melanoma of the lower extremities and trunk. Sampling of the Cloquet node should be...

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Section: 421mentioning

confidence: 99%

“…Other investigators [7][8][9][10][11] have demonstrated a survival benefit for subgroups of patients undergoing ILND and believe that ILND is a superior procedure to superficial groin dissection (SGD).…”

mentioning

confidence: 99%

Surgical Management of the Groin Lymph Nodes in Melanoma in the Era of Sentinel Lymph Node Dissection

Essner

Scheri²,

Kavanagh³

et al. 2006

Arch Surg

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“…This has prompted some to argue that the iliac nodal basin does not need to be approached unless Cloquet's node is involved with metastatic disease, and therefore, Cloquet's node essentially functions as an SLN for the iliac basin. Other predictors of iliac nodal involvement and need for complete dissection include four or more superficial groin nodes involved with disease [23,24].…”

Section: Melanomamentioning

confidence: 99%

Current Status of Sentinel Lymph Node Mapping and Biopsy: Facts and Controversies

2003

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Lymphatic mapping and sentinel lymph node biopsy were first reported in 1977 by Cabanas for penile cancer. Since that time, the technique has become rapidly assimilated into clinical practice. Morton first described the application of lymphatic mapping for melanoma only a decade ago, and this technique is now accepted as the standard of care. The application for lymphatic mapping and sentinel lymph node biopsy in breast cancer remains approximately 5 years behind its utilization in melanoma.This technique has the potential to be utilized in all solid tumors. The rapid assent of this technique in clinical practice is the result of multiple factors, including accuracy, decreased morbidity, and supplying the pathologist with only a few nodes to allow a more focused and sensitive pathologic evaluation. Despite the success and acceptance of lymphatic mapping, many controversies remain. We have attempted to clearly highlight these controversies in this review.

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“…2 of these patients died soon after operation and only 1 survived for 2.5 years and died with generalized melanoma. The massive extension of disease to the regional lymph nodes has been long recognized as an omnious sign of melanoma [7] and only an occassional patient with positive deep groin nodes will survive on a long-term basis after superficial and deep groin dissection [8]. Reports of patients with massive groin nodes from melanoma cured by hemipelvectomy are not known to us.…”

Section: Discussionmentioning

confidence: 99%

Hemipelvectomy for Neoplasms not Originating in the Pelvis

Papaioannou¹,

Papageorgiou

Volk³

1985

Oncology

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10 patients underwent hemipelvectomy, mainly for sarcomas originating high in the thigh, or melanomas and epidermoid carcinomas metastatic to the groin. 1 patient died postoperatively, 3 lived 5–12 years and 1 died of unrelated cause 2 years after the operation, all free of recurrence. Tumors treated successfully were large and with indolent locoregional growth, often despite repeated unsuccessful local treatment attempts. These tumor characteristics should be considered as favorable features, in selecting such patients for hemipelvectomy. Conversely 3 patients with melanoma had short history before and died soon after the operation, contraindicating hemipelvectomy in locally advanced melanoma.

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Results of Ilioinguinal Dissection for Stage II Melanoma

Cited by 56 publications

References 4 publications

Surgical Management of the Groin Lymph Nodes in Melanoma in the Era of Sentinel Lymph Node Dissection

Surgical Management of the Groin Lymph Nodes in Melanoma in the Era of Sentinel Lymph Node Dissection

Current Status of Sentinel Lymph Node Mapping and Biopsy: Facts and Controversies

Hemipelvectomy for Neoplasms not Originating in the Pelvis

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