Inguinal node dissection for melanoma

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Inguinal node dissection for melanoma

Postby patoco » Fri Jun 15, 2007 10:02 pm

Inguinal node dissection for melanoma in the era of sentinel lymph node biopsy.

Surgery. 2007 Jun

Sabel MS, Griffith KA, Arora A, Shargorodsky J, Blazer DG, Rees R, Wong SL, Cimmino VM, Chang AE.
Division of Surgical Oncology, the Department of Surgery, and the Biostatistics Core, University of Michigan Comprehensive Cancer Center, Ann Arbor.

BACKGROUND: With the introduction of sentinel lymph node (SLN) biopsy for melanoma, inguinal lymph node dissections (ILND) are more commonly performed for microscopic disease than for clinically palpable disease. We sought to examine the effect this change has on the morbidity of the operation.

METHODS: A retrospective review was performed of all patients who underwent an ILND for melanoma between October 1997 and April, 2006. Clinical and pathologic data were collected and correlated by multivariate analysis with the incidence of a major wound complication. RESULTS: We identified 212 patients, 132 who underwent an ILND for a positive SLN and 80 for clinically palpable disease. Age, not allowed, and body mass index (BMI) were similar in both groups. Patients with clinically palpable disease had a significantly greater number of involved nodes (3.0 vs 1.96, P = .0013), more often had >/=4 involved nodes (29% vs 9%, P < .001), and a greater incidence of extranodal extension (47% vs 5%, P < .001). Of the 212 patients, 41 (19%) had a significant wound complication. This complication was significantly higher among patients with clinical disease compared to patients with a positive SLN (28% vs 14%, P = .02). Only BMI (odds ratio of 1.1) and the indication for the procedure (odds ratio of 2.2) were independent predictors of a major wound complication.

Lymphedema occurred in 30% of the patients and was only significantly associated with clinical disease (41% vs 24%, P = .025). With a median follow-up of 2 years, regional recurrence was not significantly greater in patients with clinically palpable disease (13% vs 9%, P = not significant [ns]), although this result was possibly due to the significantly greater rate of distant recurrence (49% vs 18%, P < .001) and death (48% vs 21%) in these patients.

CONCLUSIONS: Patients undergoing an ILND for a positive SLN have a significantly lower risk of postoperative complication or lymphedema than do patients undergoing ILND for clinically palpable disease. There is a benefit in regard to the morbidity of treatment in surgically staging melanoma patients by SLN biopsy and preventing ILND for palpable disease.

PMID: 17560249 [PubMed - in process] ... d_RVDocSum

I wanted to mention as a footnote to this article, that ultra-sound guided small needle biopsies of the inguinal nodes is a much safe method then removal of the node.

My own experience with this was for lymphoma, not melanoma. However, the results confirmed the diagnosis and presented no problems in terms of aggravating my existing lymphedema.

This is an option that I believe doctors should consider when biopsing the inguinal nodes. Pat


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