Proposed quality standards for regional lymph node dissections in patients with melanoma.
OBJECTIVE
The experience of the Sydney Melanoma Unit (SMU) is documented to offer quality assurance (QA) standards and an acceptable range for lymph node yield for regional lymph node dissection (RLND) in melanoma patients.


BACKGROUND
Surgery is the most effective treatment for melanoma involving lymph nodes (LN). QA for RLND procedures, including adequacy of surgery and histopathology, is not well developed. The number of LN removed is one auditable measurement, known as a reliable predictor of surgical quality in other tumors.


METHODS
Data were retrieved from the SMU prospective database for patients treated from 1993 to 2006. There were 2039 RLND by SMU surgeons and 324 by non-SMU surgeons. The axilla, groin, cervical dissections of < or = 3 levels (CD < or = 3) and cervical dissections > or = 4 levels (CD > or = 4) were assessed.


RESULTS
At axillary dissection the mean number of LN resected by SMU surgeons was 21.9 (median 21; range 1-83; 90% of cases > or = 10 LN), groin dissection mean 14.5 LN (median 13; range 1-54; 90% of cases > or = 7 LN), CD < or = 3 dissection mean 19.5 LN (median 18.5; range 1-52; 90% of cases > or = 6 LN) and CD > or = 4 dissection mean 38.9 LN (median 36; range 5-103; 90% of cases > or = 20 LN). SMU surgeons retrieved significantly more LN than non-SMU surgeons for axillary and groin dissections (P < 0.0005).


CONCLUSIONS
These data benchmark performance for melanoma RLND. Cases with a low node count (below the 90 percentile) should be assessed critically. Standard RLND operations should have a reproducible mean and predictable distribution of LN retrieved.
Spillane
Andrew J
AJ
Melanoma Institute of Australia, and University of Sydney, North Sydney, Australia. andrew.spillane@smu.org.au
Cheung
Bernard L H
BL
Stretch
Jonathan R
JR
Scolyer
Richard A
RA
Shannon
Kerwin F
KF
Quinn
Michael J
MJ
Saw
Robyn P M
RP
McCarthy
William H
WH
Thompson
John F
JF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D019992:Databases as Topic; D005260:Female; D006801:Humans; D007223:Infant; D008197:Lymph Node Excision / Q000592:standards*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D012878:Skin Neoplasms / Q000473:pathology*; D055815:Young Adult