Abstract
Background
The aim of this study was to review the management of cervical lymph nodes in patients with cutaneous melanoma and to analyze factors influencing prognosis.
Methods
This was a retrospective cohort study of patients who had cervical node surgery at the Sydney Melanoma Unit from 1990 to 2004.
Results
Of 716 patients who met the study criteria, 339 had a sentinel node biopsy (SNB) and 396 had a neck dissection. Locoregional recurrence occurred in 27.6 % of those undergoing therapeutic neck dissection and 60 % eventually developed distant metastases. Radiotherapy was given as adjuvant treatment in 110 of the patients who had a therapeutic neck dissection (41 %), but this was not associated with improved regional control (p = .322). Multivariate analysis showed that nodal positivity (p < .001) and primary tumor ulceration (p = < .027) were the most important predictors of locoregional recurrence and that primary tumor Breslow thickness (p = .009) and node positivity (p = .046) were the most important factors predicting survival. SNB-positive patients who underwent immediate completion lymphadenectomy had a 5-year survival advantage over those who had a therapeutic neck dissection for macroscopic disease (54 % vs 47 %, p = .028).
Conclusions
Nodal status was the most important factor predicting disease-free and overall survival in patients with melanoma of the head and neck. Adjuvant radiotherapy was not associated with better locoregional control in the non-randomized cohorts of patients in this study.
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Acknowledgment
The considerable contribution of the late Professor Chris O’Brien to this study and the resulting manuscript is gratefully acknowledged.
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Martin, R.C.W., Shannon, K.F., Quinn, M.J. et al. The Management of Cervical Lymph Nodes in Patients with Cutaneous Melanoma. Ann Surg Oncol 19, 3926–3932 (2012). https://doi.org/10.1245/s10434-012-2374-7
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DOI: https://doi.org/10.1245/s10434-012-2374-7