Superficial inguinal and radical ilioinguinal lymph node dissection in patients with palpable melanoma metastases to the groin - An analysis of survival and local recurrence

The present study addresses the question whether an extended ilioinguinal d issection as compared to an only superficial inguinal dissection improves s urvival and/or local tumour control after the appearance of palpable melano ma metastases to the groin. We retrospectively analysed the data of 104 pat ients with 69 ilioinguinal and 35 superficial inguinal dissections (median follow up 127 months). Prognostic factors of survival and groin recurrence were assessed using Kaplan-Meier estimation and Cox proportional hazards mo del. By multifactorial analysis, metastatic involvement of two lymph nodes or less was associated with a significantly better survival rate than invol vement of >2 or pelvic nodes (p = 0.0002). After radical ilioinguinal disse ction, patients with extremity-located primaries had a better prognosis tha n patients with truncal primaries (p = 0.03). Tumour infiltration of the il io-obturator compartment was found to be an independent factor of poor prog nosis (p = 0.0009). The probability of recurrence in the dissected groin pa ralleled the number of positive nodes and significantly increased if intran sits were observed (p = 0.0002). The extent of surgery, Breslow thickness, epidermal ulceration, sex, age and adjuvant chemotherapy neither significan tly influenced survival nor local control rates. In summary; when metastati c inguinal nodes become palpable, the presence of pelvic metastases indicat es systemic disease. After therapeutic groin dissection, local recurrence a nd survival depend rather on regional tumour burden than on the extent of s urgery.