The efficacy of elective lymph node dissection in malignant melanoma of extremities and the trunc. An analysis in view of the sentinel-lymph node biopsy

Elective lymph node dissection (ELND) is increasingly displaced by the Sent inel-lymph node biopsy. In this view we analyzed the efficacy of ELND in th e treatment of malignant melanoma of the extremities and the trunc. Between 1979 and 1998 we performed a lymph node dissection in 834 patients (336 ma le, 498 female; average age 52 years). The analysis of the prospectively co llected data was based on those 650 patients in whom an ELND was performed for UICC-stage I (T2) to stage III melanoma. The 5-year survival rate was 7 5 % for all 650 patients. It was 87 % for patients suffering from stage I-d isease (T2 - n = 65), 86 % for those with stage II-disease (n = 354) and 47 % in case of stage III-disease (n = 231) respectively. In 7 of the 73 pati ents undergoing ELND for a T2-tumor, in 56 of the 424 patients suffering fr om T3-tumor and in 38 of the 153 patients with a T3-tumor clinically obviou s lymph node metastases had been detected by ELND. Discerning our results, we could demonstrate that a few of our patients profited from ELND, namely the patients in those clinically obvious metastases could be detected and s urvival could be achieved, i.e. 29 of all 650 electively dissected patients (2 of 7 T2N1-patients, 18 of 56 T3N1-patients and 9 of 38 T4N1-patients). We regard this benefit as an argument not to abandon the histological evalu ation of the regional lymph nodes. However, because of the limited efficacy of elective lymphadenectomy, ELND should be displaced by the less invasive Sentinel-lymph node biopsy.