Stage I Melanoma of the Limbs. Immediate versus Delayed Node Dissection

Abstract

553 patients with stage I malignant melanoma of the limbs entered a prospective randomized clinical trial carried out by the W.H.O. Collaborating Centres for Evaluation of Methods of Diagnosis and Treatment of Melanoma from September 1967 to January 1974. 286 patients were submitted to wide excision of primary and node dissection at the time as appearance of regional lymph node metastases and 267 to wide excision and immediate node dissection. Survival was identical in the 2 groups. Different subsets of patients were evaluated to assess whether some groups of patients may benefit from immediate node dissection. As regards sex, females and a significantly higher survival rate than males (p < 0.05), but results were not improved by immediate node dissection. Maximum diameter and elevation of primary melanoma were significantly related to survival but also in these cases immediate node dissection did not achieve better results. 63 patients had an excisional biopsy of their melanoma within 4 weeks before final treatment. This procedure did not worsen survival and also in this case immediate node dissection did not improve survival. 273 cases were classified according to histologic type: survival of superficial spreading and nodular melanoma was not different at a statistically significant level after the 2 treatment modalities. 325 cases were considered classifiable according to Clark's levels, out of these 165 were submitted to immediate node dissection. Neither level III nor level IV cases showed higher survival rate after immediate node dissection. Maximum tumor thickness according to Breslow was evaluated in 338 cases: 188 were submitted to wide excision and immediate node dissection. In no clusters of thickness did the enlarged surgical procedure achieve better results. The authors conclude that there is good evidence that in stage I melanoma of the extremities delayed dissection.

Cutaneous melanoma in the elderly

“…The neck dissection includes nodal levels I-V and a superficial parotidectomy should also be performed if the primary melanoma is located between the zygoma and the mastoid. The groin dissection includes the superficial and deep inguinal nodes and the ilio-obturator nodes [104][105][106][107][108][109][110][111]. Some authors have modified the neck dissection, preserving the submental and submandibular nodes (level I) for nodal metastases in the posterior triangle (level V).…”

Metastatic Squamous‐Cell Carcinomas Derived from Solar Keratosis

“…As to prophylactic node dissection, many investigators reported the results of the studies of melanoma 20–24 . In squamous‐cell carcinoma some investigators reported the incidence of lymphatic metastasis, 7,25–28 but the low rate of metastasis may make the discussion about prophylactic node dissection needless.…”

The Current Role of Sentinel Lymph Node Biopsy in Breast, Melanoma, and Gastrointestinal Cancers

“…In addition, they argued, there was no clear survival benefit for the small percentage of patients who actually had nodal disease compared with those who underwent delayed lymph node dissection (DLND) after nodal involvement became clinically apparent. 8 Several large, randomized multi-institutional studies failed to demonstrate a clear survival advantage for ELND despite earlier retrospective reports espousing significant benefit.…”