Impact of multiple lymphatic channel drainage to a single nodal basin on outcomes in melanoma.
OBJECTIVE
To determine the impact of multiple lymphatic channels (MLCs) on outcome in melanoma.


METHODS
Retrospective cohort study.


METHODS
Academic tertiary care center.


METHODS
Of 1198 consecutive selective sentinel lymphadenectomies performed from 1995 to 2000 for primary invasive melanoma, 502 patients were identified with extremity or truncal melanoma that drained to a single nodal basin. Three cohorts were formed based on lymphatic channels (none, single, and multiple). Tumors with drainage to multiple nodal basins as well as all head and neck tumors were excluded.


METHODS
Multiple variables, including patterns of lymphatic drainage, were analyzed for impact on disease-free and overall survival.


RESULTS
Demographics were similar among groups, with a median follow-up of 5.6 years. Univariate analysis revealed MLCs as an independent risk factor for both disease-free (P = .04) and overall survival (P = .003). Multivariate analysis confirmed that tumor depth, sentinel lymph node status, and MLCs were risk factors for both disease-free and overall survival. Kaplan-Meier analysis showed worse survival in the MLCs group.


CONCLUSIONS
Our study reveals that MLCs are an independent risk factor for recurrence and mortality in melanoma. Multiple lymphatic channels may facilitate the process of metastasis.
Wall
James K
JK
Department of Surgery, UCSF, San Francisco, CA 94115, USA.
Florero
Marilyn
M
Accortt
Neil A
NA
Allen
Robert
R
Kashani-Sabet
Mohamed
M
Morita
Eugene
E
Leong
Stanley P L
SP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D035002:Lower Extremity; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000000981:diagnostic imaging; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate; D013909:Thorax; D016896:Treatment Outcome; D034941:Upper Extremity