ELECTIVE LYMPH-NODE DISSECTION IN PATIENTS WITH PRIMARY MELANOMA OF THE TRUNK AND LIMBS TREATED AT THE SYDNEY MELANOMA UNIT FROM 1960 TO 1991

BACKGROUND: The value of elective lymph node dissection (ELND) in mela noma remains controversial, Published prospective and retrospective st udies can be criticized, and results from two ongoing randomized trial s are not yet available, A previous retrospective review from the Sydn ey Melanoma Unit (SMU) showed apparent survival benefit from ELND, esp ecially in tumors of intermediate thickness, STUDY DESIGN: We undertoo k a retrospective analysis of all patients treated at the SMU since 19 60 for melanoma of the trunk or limbs measuring 1.5 mm or more in thic kness, without clinical lymph node metastases, whose definitive wide e xcision (WE) with or without ELND was performed at the SMU within 60 d ays of initial diagnosis, RESULTS: There were 1,278 patients who fulfi lled these criteria, Of these, 845 (66 percent) were treated with ELND and the remaining 34 percent were treated with WE alone, The median f ollow-up period was 58 months, Patients with thicker tumors and younge r age more commonly underwent ELND, Among patients with thinner tumors , males underwent ELND more commonly than females, A multivariate prop ortional hazard model of melanoma-specific survival stratified by tumo r thickness was chosen to allow for the imbalances between the two gro ups, With or without allowance for covariates, no benefit from ELND wa s found in the whole group or any subset, In contrast to previous stud ies from the SMU, we deliberately excluded from the present study pati ents referred only after WE with or without ELND elsewhere, because th ese might have been a selectively biased poor prognostic group, CONCLU SIONS: This study does not indicate a benefit from ELND for melanomas of the trunk or limbs measuring over 1.5 mm in thickness.