title: Addition of an iliac/obturator lymph node dissection does not improve nodal recurrence or survival in melanoma.
abstract: BACKGROUND
  Controversy exists regarding the value and indications for inguinal dissection alone or in combination with an iliac/obturator lymph node dissection for melanoma.
  
  
  METHODS
  We reviewed patients from a multicenter prospective clinical trial and a single center who underwent inguinal dissection alone or combined with an iliac/obturator dissection for cutaneous melanoma. Analyses were stratified and compared by microscopic or macroscopic (palpable or detected by imaging) disease.
  
  
  RESULTS
  The study was composed of 134 patients with a median follow-up of 39 months. Indications for inguinal dissection were microscopic disease in 94 (70%) patients and macroscopic nodal disease in 40 (30%) patients. An iliac/obturator dissection yielded tumor-positive pelvic nodes in 25% vs 55% in the microscopic vs macroscopic groups, respectively (p = 0.10). No risk factors for positive pelvic nodes were identified. For both microscopic and macroscopic disease, addition of an iliac/obturator dissection to an inguinal dissection did not significantly reduce the risk of pelvic nodal recurrence. Five-year overall survival rates for 4 groups were compared: microscopic disease, inguinal dissection alone (72%); microscopic disease, iliac/obturator dissection (68%); macroscopic disease, inguinal dissection alone (51%); and macroscopic disease, iliac/obturator dissection (44%) (p = 0.0163). On survival analysis, addition of an iliac/obturator dissection in either microscopic or macroscopic disease did not affect disease-free survival or regional lymph node recurrence-free survival.
  
  
  CONCLUSIONS
  The addition of an iliac/obturator dissection to an inguinal dissection for both microscopic and macroscopic nodal disease did not significantly affect lymph node recurrence rates, disease-free survival, or overall survival.
authors.affiliation: University of Louisville, Hiram C Polk Jr MD Department of Surgery, Louisville, KY.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Egger
authors.affiliation: Cancer Surgery of Mobile, Mobile, AL.
authors.forename: Russell E
authors.initials: RE
authors.lastname: Brown
authors.affiliation: University of Louisville, Hiram C Polk Jr MD Department of Surgery, Louisville, KY.
authors.forename: Brent A
authors.initials: BA
authors.lastname: Roach
authors.affiliation: University of Louisville, Hiram C Polk Jr MD Department of Surgery, Louisville, KY.
authors.forename: Amy R
authors.initials: AR
authors.lastname: Quillo
authors.affiliation: University of Louisville, Hiram C Polk Jr MD Department of Surgery, Louisville, KY.
authors.forename: Robert C G
authors.initials: RC
authors.lastname: Martin
authors.affiliation: University of Louisville, Hiram C Polk Jr MD Department of Surgery, Louisville, KY.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Scoggins
authors.affiliation: University of Kentucky, Department of Statistics, Lexington, KY.
authors.forename: Arnold J
authors.initials: AJ
authors.lastname: Stromberg
authors.affiliation: University of Louisville, Hiram C Polk Jr MD Department of Surgery, Louisville, KY. Electronic address: mcmasters@louisville.edu.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: McMasters
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006119:Groin; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D010388:Pelvis; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome