RESULTS OF ELECTIVE LYMPH-NODE DISSECTION IN MALIGNANT-MELANOMA OF THE TRUNK

In our department, between 1979 and 1994, 253 patients, thereof 171 ma le, 83 female with the average age of 48.2 years underwent surgery bec ause of stage 1 (T2) to stage 3 melanoma that was located on the trunc . Our retrospective analysis was based on those 211 patients who had b een followed up by the department of dermatology in our medical center . It was the aim of our study-apart from determining the long-term-pro gnosis- to find out the number of patients in whom a curative resectio n could be only achieved by elective lymph node dissection. The 5-year survival rate amounted to 79 % for all patients. For patients sufferi ng from stage 1-disease (T2) it was 93 %, for those with stage 2-disea se 89 %, and in case of stage 3-disease 49 % respectively. After ELND had been performed, no lymph node metastases were found in patients (0 /22) suffering from a T2-tumor. In case of T3-tumors, in 13 % (11/82) and in case of T4-tumors in 30 % (13/ 43) lymph node metastases were f ound. However, only 5 out of 11 patients, with the established diagnos is of a T3-tumor in whom positive lymph-nodes had been found by ELND, and merely 6 out of the 13 patients with a T4-tumor, are still alive a fter a mean follow-up period of 74 months. We conclude that ELND is no t indicated in patients with T2-melanoma. In case of T3- and T4-melano ma, some doubts exist whether patients really benefit from this surgic al procedure. Randomized prospective studies are necessary to clarify the importance of electiv lymph node dissection.