Risk factors for nodal recurrence after lymphadenectomy for melanoma

Background: The risk and outcome of regional failure after elective and the rapeutic lymph node dissection (ELND/TLND) for microscopically and macrosco pically involved lymph nodes without adjuvant radiotherapy were evaluated. Methods: Retrospective melanoma database review of 338 patients (ELND 85, T LND 253) from 1970 to 1996 with pathologically involved lymph nodes. Results: Regional recurrence occurred in 14% of patients treated with ELND (n = 12) and 28% of patients treated with TLND (n = 72; P = .009). Risk fac tors associated with nodal recurrence were advanced age, primary lesion in the head and neck region, depth of the primary lesion, number of involved l ymph nodes, and extracapsular extension (ECE). For each nodal basin, the EL ND group had a lower incidence of recurrence than the TLND group. The TLND group had larger lymph nodes, greater number of involved lymph nodes, and a higher incidence of ECE. The 10-year disease-specific survival was 51% vs. 30% for ELND and TLND, respectively (P = .0005). Nodal basin failure was p redictive of distant metastasis, with 87% developing distant disease compar ed with 54% of patients without nodal recurrence (P < .0001). Of six patien ts who underwent a second dissection after isolated nodal recurrence, five patients have had a median disease-free interval of 79 months. Conclusions: After ELND or TLND, patients who have a large tumor burden (th ick primary melanoma, multiply involved lymph nodes, ECE), advanced age, an d a primary lesion located in the head and neck have a significantly increa sed likelihood of relapse and a decreased survival. Few patients present wi th an isolated nodal recurrence, but the majority can be salvaged by a seco nd dissection.