Melanoma of the clavicular region - Multimodal treatment

Hypothesis: Treatment for melanoma that has metastasized to the supraclavic ular nodes should be intensive and use a multimodality approach. Design: Retrospective analysis of clinical records. Setting: Six primary care centers, 2 of which were referral centers. Patients: Eighteen patients diagnosed as having a rare pattern of advanced melanoma metastatic to the clavicular region. Intervention: Combined radiotherapy, chemotherapy, and thorough surgical ex cision of the affected nodal basins. Main Outcome Measure: Length of survival from time of diagnosis and treatme nt to time of follow-up. Results: Median survival among the 18 patients was 28 months with a 22% sur vival rate at 5 years after diagnosis. Among patients who received radiothe rapy to the clavicular node basin, mean length Of Survival was 88.7 months with a 50% 5-year survival rate compared with a mean length of survival of 33.8 months and an 8.3% 5-year survival rate in patients who did not receiv e radiotherapy (P<.001). Mean survival among patients who had supraclavicul ar node dissection was 45.8 months with a 23.1% survival rate at 5 years af ter diagnosis, compared with a mean survival of 52 months and a 20% 5-year survival rate among patients who did not receive therapeutic lymphadenectom y. Of the 11 patients who had therapeutic lymphadenectomy, 2 also received radiotherapy to the supraclavicular nodal basin and continued to be disease -free at 82 and 130 months. All long-term survivors had been treated with i ntraarterial chemotherapy. Conclusion: In a series of patients with malignant melanoma metastatic to t he clavicular lymph nodes, multimodality treatment using radiotherapy, chem otherapy, and thorough surgical excision of affected nodal basins provided an appreciable 5-year survival rate.