Regional nodal basin control is not compromised by previous sentinel lymphnode biopsy in patients with melanoma

Background: Regional nodal basin control is an important goal of lymphadene ctomy in the management of melanoma patients with nodal disease. The purpos e of this study was to determine if previous sentinel lymph node (SLN) biop sy compromises the ultimate regional nodal control achieved by subsequent t herapeutic lymph node dissection in melanoma patients with microscopic lymp h node metastases. Methods: A surgical melanoma database and hospital records were reviewed fo r 602 patients with primary cutaneous melanoma who underwent successful lym phatic mapping and SLN biopsy between 1991 and 1997. Results: A total of 105 (17%) of 602 patients had histologically positive S LNs and were offered therapeutic lymphadenectomy; 101 (96%) underwent this procedure, Thirty-six patients (36%) developed recurrent melanoma at one or more sites. The median follow-up period was 30 months. Recurrence in the p reviously dissected nodal basin was observed in 10 patients (10%); none had recurrence at only that site. Nodal basin disease appeared after local/in- transit (n = 6) or distant (n = 1) failure in seven patients and, as a comp onent of the first site of Failure, simultaneously with local/in-transit (n = 2) or distant (n = 1) recurrence in three patients. Conclusions: Nodal basin failure after lymphadenectomy in patients who unde rwent previous biopsy of a histologically positive SLN is primarily a funct ion of aggressive locoregional disease rather than of contamination from pr evious surgery. Because regional nodal control was comparable with that in other series, we conclude that SLN biopsy with selective lymphadenectomy do es not compromise regional nodal basin control.