Therapeutic node dissections in malignant melanoma

Karakousis, Constantine P.

doi:10.1007/bf02303638

Cited by 49 publications

(42 citation statements)

References 46 publications

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“…Most authors concur that the extent of dissection should include Level I, II, and III lymph nodes, although some include Level III only when suspicious nodes are present [22][23][24]. With this approach, local recurrence is reported in 3-17% of patients (Table II) [21,[25][26][27].…”

Section: Axillary Dissection Extent Of Dissectionmentioning

confidence: 96%

“…In practice, no increase in complications was noted by Karakousis et al with this approach although there was no concurrent comparison group [26]. Preservation of the long thoracic and thoracodorsal nerve is considered routine although the intercostobrachial nerves are often resected in a therapeutic nodal dissection [22,23].…”

Section: Axillary Dissection Extent Of Dissectionmentioning

confidence: 97%

“…The options for skin incision include: an oblique or sigmoid shaped incision from just medial to the anterior superior iliac spine to the inferior margin of the femoral triangle, paired oblique incisions (above and below the inguinal crease), or a oblique/ transverse incision above the crease with a longitudinal incision below and a skin bridge between [22,27,57]. Proponents of the oblique/sigmoid incision cite optimal exposure and less subcutaneous lymphatic disruption as advantages of this incision [22]. In contrast, oblique/ transverse or a combination of incisions are primarily employed to avoid an incision in the inguinal crease with the goal of decreasing wound complications [27].…”

Section: Technical Variablesmentioning

confidence: 99%

“…The most controversial area is the choice between a superficial inguinal lymphadenectomy alone or the routine addition of deep iliac and obturator lymphadenectomy [23,24,[36][37][38][39]. The arguments for either option involve potential differences in overall survival, local control rates, and significant morbidity.…”

Section: Groin Dissection Extent Of Dissectionmentioning

confidence: 99%

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Controversies in the management of metastatic melanoma to regional lymphatic basins

Mack

McKinnon

2004

Journal of Surgical Oncology

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The primary management of lymph nodes involved with metastatic melanoma is regional lymphadenectomy. Many controversies of regional lymph node dissection exist including extent and nature of the lymphadenectomy, treatment of lymphatic metastases in unusual locations and the role of adjuvant radiotherapy. Although radical neck dissection has been the gold standard for cervical disease, modified dissections do not seem to compromise regional control in appropriately selected patients. In the axilla, a Level I, II, and III dissection is most commonly performed. Combined superficial and deep groin dissection is justified for clinically palpable disease although management of patients with histologically positive yet clinically non-palpable disease is more controversial. Burden of disease, imaging, patient co-morbidity, and Cloquet nodal status must be considered. Many technical variations exist in an attempt to improve morbidity rates secondary to lymphadenectomy. Unfortunately, complication rates are difficult to compare secondary to variable study designs, definitions, and patient populations. Adjuvant radiation therapy appears warranted in patients with high risk of regional recurrence including bulky disease, extracapsular extension or cervical location.

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Section: Axillary Dissection Extent Of Dissectionmentioning

confidence: 96%

Section: Axillary Dissection Extent Of Dissectionmentioning

confidence: 97%

Section: Technical Variablesmentioning

confidence: 99%

Section: Groin Dissection Extent Of Dissectionmentioning

confidence: 99%

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Controversies in the management of metastatic melanoma to regional lymphatic basins

Mack

McKinnon

2004

Journal of Surgical Oncology

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“…ELND is associated with a considerable complication rate and is no longer recommended [16]. The SLNB concept to evaluate the clinically negative regional nodal basin(s) was initially reported by Cabanas [17] for penile cancer and later described for melanoma by Morton et al in 1992 [18].…”

Section: Management Of Primary Melanoma With Clinically Negative Lympmentioning

confidence: 99%

Lymph node assessment in melanoma

Easson

Rotstein

McCready

2008

Journal of Surgical Oncology

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The surgical management of lymph nodes continues to be important in melanoma since effective systemic therapies are not available. Controversy exists around the significance of the early detection and management of microscopically positive lymph nodes detected by sentinel lymph node biopsy and this is the subject of current surgical clinical trials. Complete lymphadenectomy is recommended for lymph node metastases. The importance of proper surgical technique is discussed.

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Melanoma of the Clavicular Region

Lam

Krementz²,

McGinness³

et al. 2001

Arch Surg

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Treatment for melanoma that has metastasized to the supraclavicular nodes should be intensive and use a multimodality approach. Design: Retrospective analysis of clinical records. Setting: Six primary care centers, 2 of which were referral centers. Patients: Eighteen patients diagnosed as having a rare pattern of advanced melanoma metastatic to the clavicular region. Intervention: Combined radiotherapy, chemotherapy, and thorough surgical excision of the affected nodal basins. Main Outcome Measure: Length of survival from time of diagnosis and treatment to time of follow-up. Results: Median survival among the 18 patients was 28 months with a 22% survival rate at 5 years after diagnosis. Among patients who received radiotherapy to the clavicular node basin, mean length of survival was 88.7 months with a 50% 5-year survival rate compared with a mean length of survival of 33.8 months and an 8.3% 5-year survival rate in patients who did not receive radiotherapy (PϽ.001). Mean survival among patients who had supraclavicular node dissection was 45.8 months with a 23.1% survival rate at 5 years after diagnosis, compared with a mean survival of 52 months and a 20% 5-year survival rate among patients who did not receive therapeutic lymphadenectomy. Of the 11 patients who had therapeutic lymphadenectomy, 2 also received radiotherapy to the supraclavicular nodal basin and continued to be disease-free at 82 and 130 months. All long-term survivors had been treated with intraarterial chemotherapy. Conclusion: In a series of patients with malignant melanoma metastatic to the clavicular lymph nodes, multimodality treatment using radiotherapy, chemotherapy, and thorough surgical excision of affected nodal basins provided an appreciable 5-year survival rate.

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Therapeutic node dissections in malignant melanoma

Cited by 49 publications

References 46 publications

Controversies in the management of metastatic melanoma to regional lymphatic basins

Controversies in the management of metastatic melanoma to regional lymphatic basins

Lymph node assessment in melanoma

Melanoma of the Clavicular Region

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