Lymph node biopsy does not impair survival after therapeutic dissection for palpable melanoma metastases

Background: To determine the effects of disrupting a nodal basin in patient s with American Joint Committee on Cancer stage III melanoma with clinicall y palpable lymph nodes, we studied patients who underwent therapeutic lymph node dissection after excisional lymph node biopsy, after fine-needle aspi ration (FNA) biopsy, or without a preoperative biopsy. Methods: We performed a retrospective review of our patients with American Joint Committee on Cancer stage III melanoma who were treated between Janua ry 1972 and June 1995, using data acquired from our 8200-patient database. The study group included 670 patients with melanoma, with known primary tum ors, who underwent therapeutic lymph node dissection for palpable nodal met astases diagnosed by open biopsy (227 patients), by FNA (66 patients), or b y clinical observation without biopsy (377 patients). Regional node recurre nce, 5-year disease-free survival, and overall survival rates were calculat ed. Results: The same-basin regional node recurrence rates were similar for the three groups (open biopsy, 4.6%; FNA, 3.2%; no biopsy, 4.6%; P = .14). The 5-year disease-free survival rates were 36.8% for the open-biopsy group, 2 9.6% for the FNA group, and 28.9% for the no-biopsy group (P = .08); corres ponding 5-year overall survival rates were 40.6%, 43.9%, and 36.1%, respect ively (P = .18). Multivariate analysis failed to identify preoperative biop sy as a significant risk factor. Matched-pair analysis using age, gender, p rimary tumor site, Breslow thickness, and tumor burden showed no difference s in the 5-year disease-free survival rates (33% for the open-biopsy group vs. 27% for the FNA and no-biopsy groups, P = .42) and the 5-year overall s urvival rates (41% vs. 35%, P = .32). Conclusions: For patients with melanoma with palpable regional adenopathy, histological confirmation of clinical suspicion with either FNA or excision al lymph node biopsy does not adversely affect survival or recurrence rates .