Risk Factors for Nodal Recurrence After Lymphadenectomy for Melanoma

Abstract

After ELND or TLND, patients who have a large tumor burden (thick primary melanoma, multiply involved lymph nodes, ECE), advanced age, and a primary lesion located in the head and neck have a significantly increased likelihood of relapse and a decreased survival. Few patients present with an isolated nodal recurrence, but the majority can be salvaged by a second dissection.

Controversies in the management of metastatic melanoma to regional lymphatic basins

“…Furthermore, many studies have identified high-risk features resulting in regional recurrence rates of 15-60% [7,69,[71][72][73][74][75] (Tables I and II). Regional recurrence is significantly associated with an increasing number of positive lymph nodes and extracapsular extension of melanoma [69,71,72]. Calabro et al noted a 9% risk of recurrence following lymphadenectomy with one positive lymph node against a 15-33% risk correlated to increasing number of positive nodes [69].…”

“…Similarly, an 18% recurrence rate was determined among 403 patients after axillary or inguinal lymphadenectomy in another large series [70]. Furthermore, many studies have identified high-risk features resulting in regional recurrence rates of 15-60% [7,69,[71][72][73][74][75] (Tables I and II). Regional recurrence is significantly associated with an increasing number of positive lymph nodes and extracapsular extension of melanoma [69,71,72].…”

Role of postoperative irradiation for patients with bilateral cervical nodal metastases from cutaneous melanoma: A critical assessment

“…[6][7][8][9] Also, some investigators have demonstrated that cervical location of nodal disease was itself an adverse prognostic factor, with associated rates of recurrence in the neck of 30% to 40%. 6,9,21 These data were compared with data reporting regional recurrence rates of approximately 10% when analyzing series of patients with these high-risk features who were treated with surgery followed by postoperative RT. 4,5 In our series of patients with simultaneous bilateral cervical metastases, the regional nodal control was only 64% at 1 year.…”

Lymph node assessment in melanoma

“…It is recommended that post-lymphadenectomy radiation should be considered in patients with these factors in order to reduce the risk of nodal recurrence [73,74]. Nodal recurrence is predictive of distant metastasis and poor survival [75]. Isolated nodal recurrence should be re-excised, and long term survival is possible in these patients [75,76].…”

“…Nodal recurrence is predictive of distant metastasis and poor survival [75]. Isolated nodal recurrence should be re-excised, and long term survival is possible in these patients [75,76].…”