title: Inguinal node dissection for melanoma in the era of sentinel lymph node biopsy.
abstract: BACKGROUND
  With the introduction of sentinel lymph node (SLN) biopsy for melanoma, inguinal lymph node dissections (ILND) are more commonly performed for microscopic disease than for clinically palpable disease. We sought to examine the effect this change has on the morbidity of the operation.
  
  
  METHODS
  A retrospective review was performed of all patients who underwent an ILND for melanoma between October 1997 and April, 2006. Clinical and pathologic data were collected and correlated by multivariate analysis with the incidence of a major wound complication.
  
  
  RESULTS
  We identified 212 patients, 132 who underwent an ILND for a positive SLN and 80 for clinically palpable disease. Age, sex, and body mass index (BMI) were similar in both groups. Patients with clinically palpable disease had a significantly greater number of involved nodes (3.0 vs 1.96, P = .0013), more often had >or=4 involved nodes (29% vs 9%, P < .001), and a greater incidence of extranodal extension (47% vs 5%, P < .001). Of the 212 patients, 41 (19%) had a significant wound complication. This complication was significantly higher among patients with clinical disease compared to patients with a positive SLN (28% vs 14%, P = .02). Only BMI (odds ratio of 1.1) and the indication for the procedure (odds ratio of 2.2) were independent predictors of a major wound complication. Lymphedema occurred in 30% of the patients and was only significantly associated with clinical disease (41% vs 24%, P = .025). With a median follow-up of 2 years, regional recurrence was not significantly greater in patients with clinically palpable disease (13% vs 9%, P = not significant [ns]), although this result was possibly due to the significantly greater rate of distant recurrence (49% vs 18%, P < .001) and death (48% vs 21%) in these patients.
  
  
  CONCLUSIONS
  Patients undergoing an ILND for a positive SLN have a significantly lower risk of postoperative complication or lymphedema than do patients undergoing ILND for clinically palpable disease. There is a benefit in regard to the morbidity of treatment in surgically staging melanoma patients by SLN biopsy and preventing ILND for palpable disease.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA.msabel@umich.edu <msabel@umich.edu>
authors.forename: Michael S
authors.initials: MS
authors.lastname: Sabel
authors.forename: Kent A
authors.initials: KA
authors.lastname: Griffith
authors.forename: Alisha
authors.initials: A
authors.lastname: Arora
authors.forename: Josef
authors.initials: J
authors.lastname: Shargorodsky
authors.forename: Dan G
authors.initials: DG
authors.lastname: Blazer
authors.forename: Riley
authors.initials: R
authors.lastname: Rees
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Wong
authors.forename: Vincent M
authors.initials: VM
authors.lastname: Cimmino
authors.forename: Alfred E
authors.initials: AE
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D006119:Groin; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects; D008209:Lymphedema / Q000209:etiology; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010173:Palpation; D012189:Retrospective Studies; D018570:Risk Assessment; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology*; D016019:Survival Analysis