Long-term survival in 2,505 patients with melanoma with regional lymph node metastasis.
OBJECTIVE
To examine the long-term outcomes of patients with melanoma metastatic to regional lymph nodes.


BACKGROUND
Regional lymph node metastasis is a major determinant of outcome for patients with melanoma, and the presence of regional lymph node metastasis has been commonly used as an indication for systemic, often intensive, adjuvant therapy. However, the risk of recurrence varies greatly within this heterogeneous group of patients.


METHODS
Database review identified 2,505 patients, referred to the Duke University Melanoma Clinic between 1970 and 1998, with histologic confirmation of regional lymph node metastasis before clinical evidence of distant metastasis and with documentation of full lymph node dissection. Recurrence and survival after lymph node dissection were analyzed.


RESULTS
Estimated overall survival rates at 5, 10, 15, and 20 years were 43%, 35%, 28%, and 23%, respectively. This population included 792 actual 5-year survivors, 350 10-year survivors, and 137 15-year survivors. The number of positive lymph nodes was the most powerful predictor of both overall survival and recurrence-free survival; 5-year overall survival rates ranged from 53% for one positive node to 25% for greater than four nodes. Primary tumor ulceration and thickness were also powerful predictors of both overall and recurrence-free survival in multivariate analyses. The most common site of first recurrence after lymph node dissection was distant (44% of all patients).


CONCLUSIONS
Patients with regional lymph node metastasis can enjoy significant long-term survival after lymph node dissection. Therefore, aggressive surgical therapy of regional lymph node metastases is warranted, and each individual's risk of recurrence should be weighed against the potential risks of adjuvant therapy.
White
Rebekah R
RR
Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Stanley
Wilma E
WE
Johnson
Jeffrey L
JL
Tyler
Douglas S
DS
Seigler
Hilliard F
HF
D000328:Adult; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis; D017741:Survivors