THERAPEUTIC NODE DISSECTIONS IN MALIGNANT-MELANOMA

Background: Therapeutic lymphadenectomies involve the dissection and r emoval of clinically enlarged, histologically positive nodes at the re gional nodal basin, in the absence of detectable distant disease. Meth ods: The literature dealing with therapeutic lymphadenectomies in mali gnant melanoma was reviewed. Results: The rate of wound complications varies with the particular nodal basin. The 5-year survival varies fro m 19% to 38%, with an average of 26%. Survival is affected primarily b y the number of histologically positive nodes and extracapsular spread , and secondarily by the extent of disease at the various levels of th e nodal basin, fixation of the nodes, and, probably, the preceding dis ease-free interval. Prognostic parameters of the primary lesion, e.g., thickness, ulceration, and location, also may have an effect on survi val. The rate of local recurrence at the nodal basin after lymphadenec tomy has varied from 0.8% to 52%. Adjuvant therapy with interferon alf a-2b has improved the 5-year disease-free survival from 26% to 37%. Co nclusions: Therapeutic node dissections in melanoma provide an appreci able 5-year survival rate, which is further augmented by adjuvant ther apy. Many series report a significant rate of local recurrence at the nodal basin following therapeutic dissection. Complete lymphadenectomy reduces the rate of local failure with its attendant morbidity.