title: Melanoma of the clavicular region: multimodal treatment.
abstract: OBJECTIVE
  Treatment for melanoma that has metastasized to the supraclavicular nodes should be intensive and use a multimodality approach.
  
  
  METHODS
  Retrospective analysis of clinical records.
  
  
  METHODS
  Six primary care centers, 2 of which were referral centers.
  
  
  METHODS
  Eighteen patients diagnosed as having a rare pattern of advanced melanoma metastatic to the clavicular region.
  
  
  METHODS
  Combined radiotherapy, chemotherapy, and thorough surgical excision of the affected nodal basins.
  
  
  METHODS
  Length of survival from time of diagnosis and treatment to time of follow-up.
  
  
  RESULTS
  Median survival among the 18 patients was 28 months with a 22% survival rate at 5 years after diagnosis. Among patients who received radiotherapy 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 receive radiotherapy (P<.001). Mean survival among patients who had supraclavicular node dissection was 45.8 months with a 23.1% survival rate at 5 years after diagnosis, compared with a mean survival of 52 months and a 20% 5-year survival rate among patients who did not receive therapeutic lymphadenectomy. 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 intra-arterial chemotherapy.
  
  
  CONCLUSIONS
  In a series of patients with malignant melanoma metastatic to the clavicular lymph nodes, multimodality treatment using radiotherapy, chemotherapy, and thorough surgical excision of affected nodal basins provided an appreciable 5-year survival rate.
authors.affiliation: Department of Surgery, Kaiser Permanente Medical Center, 280 W MacArthur Blvd, Oakland, CA 94611-5693, USA.
authors.forename: L
authors.initials: L
authors.lastname: Lam
authors.forename: E
authors.initials: E
authors.lastname: Krementz
authors.forename: C
authors.initials: C
authors.lastname: McGinness
authors.forename: R
authors.initials: R
authors.lastname: Godfrey
mesh_terms: D000328:Adult; D002968:Clavicle; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D008875:Middle Aged; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology*; D015996:Survival Rate