IMPROVED PROGNOSIS FOR DEFINED RISK GROUP S BY LYMPH-NODE DISSECTION - LONG-TERM STUDY OF 3616 MELANOMA PATIENTS

Nine medical centres with different practices in elective lymph node d issection (ELND) but comparable standards regarding diagnosis, excisio n of the primary tumour, classification, and follow-up, have collected their data on 3616 patients with primary melanoma of the skin (tumour category pT 2 to pT 4a, N 0, M 0 [UICC 1987] with the aim of producin g an unbiased analysis of the prognostic benefit of ELND. The mutlivar iate risk analysis (Cox's proportional hazard model) revealed tumour t hickness (Breslow or alternative pT categories), sex, anatomic site of the primary tumour, and ELND therapy (,,yes'' or ,,no'') as independe nt prognostic factors. Observed survival curves (Kaplan-Meier) show a significant difference of prognosis with regard to ELND therapy in the following risk groups: women with melanomas over 2.5 to 4 mm thick on head, neck, thorax, and in acral locations; men with melanomas over 1 .5 to 4 mm thick on head, neck, thorax, and in acral locations; and fi nally men with melanomas over 2.5 to 4 mm thick on abdomen and extremi ties. Further investigations and the discovery of additional prognosti c factors would help in more precisely formulation of guidelines for E LND.