Source
Division of Surgical Oncology, Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40292. charles.scoggins@louisville.edu.
Abstract
HYPOTHESIS:
The number of nodal basins draining a primary cutaneous melanoma is not an independent predictor of outcome.
DESIGN:
Post hoc analysis of patients entered into a randomized, prospective study.
SETTING:
Multi-institutional academic and community medical centers.
PATIENTS:
Patients aged 18 to 70 years with melanoma 1.0 mm or greater Breslow thickness.
INTERVENTIONS:
Wide local excision and sentinel lymph node biopsy were performed on all patients; patients with sentinel lymph node metastases underwent completion lymphadenectomy. Patients with multiple-nodal basin drainage were compared with those with single-nodal basin drainage.
MAIN OUTCOME MEASURES:
Sentinel lymph node status, locoregional recurrence-free survival, disease-free survival, and overall survival.
RESULTS:
A total of 2060 patients with single-nodal basin drainage (n = 1709 [83% of cohort]) were included in the analysis, with a median follow-up of 50 months. On univariate analysis, the group with multiple-nodal basin drainage (n = 351) was associated with female sex and primary tumor regression (P < .001). In addition, multiple-nodal basin drainage was associated with truncal primary tumor location (73.2%), while single-nodal basin drainage was more common for extremity tumors (50.9%; P < .001). On multivariate analysis, there were no differences in the rate of sentinel lymph node metastasis, disease-free survival, or overall survival between the groups. Interestingly, locoregional recurrence was significantly worse in the single-nodal basin drainage group (P = .003).
CONCLUSIONS:
Multiple-nodal basin drainage does not confer a worse prognosis for patients with cutaneous melanoma. In fact, single-nodal basin drainage appears to be associated with a greater risk of locoregional recurrence.