LOCAL-CONTROL FOLLOWING THERAPEUTIC NODAL DISSECTION FOR MELANOMA

Regional recurrence of melanoma is usually treated with surgical resec tion alone. Unfortunately sites of failure following surgical resectio n are poorly documented. Little information exists regarding local fai lure following surgery. In order to define local control, a retrospect ive analysis was per-formed of all patients undergoing a potentially c urative lymph node dissection for metastatic melanoma. From 1978 to 19 88, 48 patients underwent lymph node dissection with removal of all kn own disease (15 axillary, 25 groin and 8 radical neck dissections). Se ven patients had stage II disease with simultaneous resection of the p rimary lesion and nodal dissection. The remaining 41 patients had stag e I disease with dissection delayed until nodal metastasis became appa rent. Of these 48 patients, 25 experienced local failure for an overal l local control rate of 48%. Univariate and multivariate analysis show ed only age to be a statistically significant prognostic indicator of local failure with a rate of 31% for patients <50 years of age vs. 66% for patients >50 years of age (P = 0.02). Nodal size, number of nodes involved, extracapsular extension, initial stage, location, or sex di d not influence prognosis. Although not statistically significant, tim e to recurrence was much shorter in patients with extracapsular extens ion, 5 months vs. 16 months. With an overall local failure rate of 52% following a potentially curable therapeutic nodal dissection further local treatment should be considered. (C) 1993 Wiley-Liss, Inc.