Staging Laparotomy in the Treatment of Metastatic Melanoma of the Lower Extremities

Abstract

Twenty-six consecutive patients with melanoma of the lower extremities metastatic to the superficial inguinal lymph nodes were subjected to laparotomy. No patient had preoperative evidence of tumor dissemination past the superficial inguinal nodes. However three patients (12%) had metastases to the liver or para-aortic lymph nodes documented at laparotomy and were not subjected to iliac and obturator lymph node dissection. One of these patients had concomitant local recurrence of melanoma at the ankle. The other two patients had superficial inguinal lymph nodes at least 5 cm in diameter, although two other such patients with similar 5 cm lymph nodes did not have positive intra-abdominal findings. The remaining 23 of the 26 patients underwent ipsilateral iliac and obturator lymph node dissection, which proved positive in 3/23 patients (13%). Of these 23 patients undergoing iliac and obturator node dissection, 18 had clinically positive (and microscopically positive) superficial inguinal nodes prior to their dissection, while the remaining 5 patients had clinically negative (but microscopically positive) superficial inguinal nodes. The three cases of positive dissected iliac and obturator nodes occurred among the 18 patients with clinically positive superficial inguinal nodes (17%). Among the 5 patients with clinically negative, microscopically positive superficial groin nodes, there was no detectable deep inguinal nodal spread (or hepatic or para-aortic involvement).

Surgical treatment of malignant melanoma of the skin

“…Inguino-femoral, external iliac, and obturator nodes must be removed when inguinal nodes are involved. A few years ago, Cohen et al [10] suggested laparotomy as a staging procedure. In 5 patients, they found occult para-aortic lymph node metastases, and in 2 of these patients there were occult liver metastases.…”

Surgical Management of Advanced Cutaneous Malignant Melanoma

“…The likelihood then of widespread, disseminated disease is great, and such patients require extensive study by many of the currently available techniques like conventional radiography, radionuclear scans of liver and bone, pulmonary tomography, and gallium scanning. Even if these studies are negative, in a patient with a malignant melanoma on a lower extremity who presents himself with bulky groin metastases, staging by laparotomy is prudent prior to embarking on a surgical procedure that may require both extensive resections to control a primary lesion or a local recurrence and dissection of inguinal‐femoral and iliac‐obturator nodes. As the first step in the treatment of such a patient, laparotomy may be carried out through a lower midline incision to secure biopsy specimens of paraaortic nodes and to palpate the liver for distant spread.…”

Immunotherapy and chemoimmunotherapy of malignant disease with BCG and nonviable mycobacterial fractions

“…The largest series with the most convincing demonstration of the efficacy of this therapeutic approach is that of Morton et al [94], who demonstrated in 36 patients that 684 of 754 injected nodules regressed completely following intralesional BCG. Cohen et al [99] reported the regression of 119 of 123 BCG-injected nodules in 4 patients. Regression of uninjected nodules occurred in 15-20% of patients.…”

“…Nathanson has reported patients having a complete response for more than 19 months [103]. Long-term survivors of greater than 5 years have been reported from the National Cancer Institute [97,99]. Long-term survival of patients following successful intralesional BCG therapy appears to occur only in patients with purely cutaneous metastatic disease.…”