Effect of multiple-nodal basin drainage on cutaneous melanoma.
OBJECTIVE
The number of nodal basins draining a primary cutaneous melanoma is not an independent predictor of outcome.


METHODS
Post hoc analysis of patients entered into a randomized, prospective study.


METHODS
Multi-institutional academic and community medical centers.


METHODS
Patients aged 18 to 70 years with melanoma 1.0 mm or greater Breslow thickness.


METHODS
Wide local excision and sentinel lymph node biopsy were performed on all patients; patients with sentinel lymph node metastases underwent completion lymphadenectomy. Patients with multiple-nodal basin drainage were compared with those with single-nodal basin drainage.


METHODS
Sentinel lymph node status, locoregional recurrence-free survival, disease-free survival, and overall survival.


RESULTS
A total of 2060 patients with single-nodal basin drainage (n = 1709 [83% of cohort]) were included in the analysis, with a median follow-up of 50 months. On univariate analysis, the group with multiple-nodal basin drainage (n = 351) was associated with female sex and primary tumor regression (P < .001). In addition, multiple-nodal basin drainage was associated with truncal primary tumor location (73.2%), while single-nodal basin drainage was more common for extremity tumors (50.9%; P < .001). On multivariate analysis, there were no differences in the rate of sentinel lymph node metastasis, disease-free survival, or overall survival between the groups. Interestingly, locoregional recurrence was significantly worse in the single-nodal basin drainage group (P = .003).


CONCLUSIONS
Multiple-nodal basin drainage does not confer a worse prognosis for patients with cutaneous melanoma. In fact, single-nodal basin drainage appears to be associated with a greater risk of locoregional recurrence.
Federico
Andrea C
AC
Division of Surgical Oncology, Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40292. charles.scoggins@louisville.edu.
Chagpar
Anees B
AB
Ross
Merrick I
MI
Martin
Robert C G
RC
Noyes
R Dirk
RD
Goydos
James S
JS
Beitsch
Peter D
PD
Urist
Marshall M
MM
Ariyan
Stephan
S
Sussman
Jeffrey J
JJ
McMasters
Kelly M
KM
Scoggins
Charles R
CR
D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis