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Ann Surg Oncol. 2012 Nov;19(12):3926-32. doi: 10.1245/s10434-012-2374-7. Epub 2012 Jun 6.

The management of cervical lymph nodes in patients with cutaneous melanoma.

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1
Melanoma Institute Australia (Formerly the Sydney Melanoma Unit), North Sydney, NSW, Australia.

Abstract

BACKGROUND:

The aim of this study was to review the management of cervical lymph nodes in patients with cutaneous melanoma and to analyze factors influencing prognosis.

METHODS:

This was a retrospective cohort study of patients who had cervical node surgery at the Sydney Melanoma Unit from 1990 to 2004.

RESULTS:

Of 716 patients who met the study criteria, 339 had a sentinel node biopsy (SNB) and 396 had a neck dissection. Locoregional recurrence occurred in 27.6 % of those undergoing therapeutic neck dissection and 60 % eventually developed distant metastases. Radiotherapy was given as adjuvant treatment in 110 of the patients who had a therapeutic neck dissection (41 %), but this was not associated with improved regional control (p = .322). Multivariate analysis showed that nodal positivity (p < .001) and primary tumor ulceration (p = < .027) were the most important predictors of locoregional recurrence and that primary tumor Breslow thickness (p = .009) and node positivity (p = .046) were the most important factors predicting survival. SNB-positive patients who underwent immediate completion lymphadenectomy had a 5-year survival advantage over those who had a therapeutic neck dissection for macroscopic disease (54 % vs 47 %, p = .028).

CONCLUSIONS:

Nodal status was the most important factor predicting disease-free and overall survival in patients with melanoma of the head and neck. Adjuvant radiotherapy was not associated with better locoregional control in the non-randomized cohorts of patients in this study.

PMID:
22669449
DOI:
10.1245/s10434-012-2374-7
[Indexed for MEDLINE]
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