Radical lymph node dissection for melanoma.
BACKGROUND
Therapeutic lymph node dissection for melanoma aims to achieve regional disease control. Radical lymphadenectomy (RLND) can be a difficult procedure associated with significant postoperative morbidity. The aims of the present study were to review regional disease control and morbidity in a series of lymphadenectomies performed within a specialist unit.


METHODS
The present study involved the analysis of 73 lymphadenectomies in 64 patients, from 1995 to 2001.


RESULTS
The overall wound complication rate after inguinal lymphadenectomy (71%) was higher than after axillary lymphadenectomy (47%; P = 0.05). After inguinal lymphadenectomy, the wound infection rate was higher (25.0%vs 5.9%; P = 0.03), delayed wound healing was more frequent (25.0%vs 5.9%; P = 0.03), and the mean time that drain tubes remained in situ was longer (12.5 vs 8.2 days; P = 0.05). There were no significant differences in seroma (46%vs 32%) rates. Lymphoedema was more common after inguinal lymphadenectomy (P < 0.02). Multivariate analysis identified inguinal RLND (P = 0.002) and increasing tumour size (P = 0.045) as predictors of wound morbidity. More patients received postoperative radiotherapy after neck RLND compared to inguinal or axilla RLND (P = 0.03). Six (8%) patients developed local recurrence after lymphadenectomy. At a median follow up of 22 months, 34 (53%) patients have died, from disseminated disease.


CONCLUSIONS
Radical lymphadenectomy for melanoma is associated with significant morbidity. Inguinal node dissection has a higher rate of complications than axillary dissection. Low local recurrence rates can be achieved, limiting the potential morbidity of uncontrolled regional metastatic disease.
Serpell
Jonathan W
JW
The Alfred and Frankston Hospitals, the Victorian Melanoma Service, The Alfred Hospital, the Department of Surgery, Monash University, Victoria, Australia. jwserpell@ozemail.com.au
Carne
Peter W G
PW
Bailey
Michael
M
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000517:prevention & control*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D012189:Retrospective Studies; D012871:Skin Diseases / Q000401:mortality / Q000601:surgery*; D013530:Surgical Wound Infection / Q000209:etiology* / Q000401:mortality; D015996:Survival Rate