title: Number of excised lymph nodes as a quality assurance measure for lymphadenectomy in melanoma.
abstract: OBJECTIVE
  Although the number of excised lymph nodes (LNs) represents a quality assurance measure in lymphadenectomy for many solid tumors, the minimum number of LNs to be dissected has not been established for melanoma.
  
  
  OBJECTIVE
  To investigate the distribution of the number of excised LNs in a large patient series (N = 2526) to identify values that may serve as benchmarks for monitoring the quality of lymphadenectomy in patients with melanoma.
  
  
  METHODS
  A retrospective multicenter study was conducted (1992-2010) in tertiary referral centers for treatment of cutaneous melanoma. Medical records on 2526 patients who underwent lymphadenectomy for regional LN metastasis associated with cutaneous melanoma were examined.
  
  
  METHODS
  Patients had undergone lymphadenectomy for regional LN metastasis.
  
  
  METHODS
  The mean, median, and 10th percentile of the number of excised LNs were calculated for the axilla (3 levels), neck (≤3 or ≥4 dissected levels), inguinal, and ilioinguinal LN fields.
  
  
  RESULTS
  After 3-level axillary (n = 1150), 3-level or less neck (n = 77), 4-level or more neck (n = 135), inguinal (n = 209), and ilioinguinal (n = 955) dissections, the median (interquartile range [IQR]) and mean (SD) number of excised LNs were as follows: 3-level axillary dissection, 20 (15-27) and 22 (8); 3-level or less neck, 21 (14-33) and 24 (15); 4-level or more neck, 29 (21-41) and 31 (14); inguinal, 11 ( 9-14) and 12 (5); and ilioinguinal, 21 (16-26) and 22 (4). A total of 90% of the patients had 12, 7, 14, 6, and 13 excised LNs (10th percentile of the distribution) after 3-level axillary, 3-level or less neck, 4-level or more neck, inguinal, and ilioinguinal dissections, respectively. More excised LNs were detected in younger (21 for those <54 years of age and 19 for ≥54 years, P < .001) and male (21 for male sex and 19 for female sex, P < .001) patients from high-volume institutions (21 for volume of ≥300 vs 18 for volume <300, P < .001) with a more recent year of diagnosis (21 for years 2002-2010 vs 18 for years 1992-2001, P < .001), LN micrometastasis vs macrometastasis (20 vs 19, P = .005), and more positive LNs (R² = 0.03, P < .001); however, the differences between median values were small.
  
  
  CONCLUSIONS
  These minimum numbers of excised LNs are reproducible across the institution, patient, and tumor factors evaluated. They can be taken into consideration when monitoring the quality of lymphadenectomy in melanoma and can represent entry criteria for randomized trials investigating adjuvant therapies.
authors.affiliation: Melanoma and Sarcoma Unit, Veneto Institute of Oncology, Padova, Italy2Surgery Branch, Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy.
authors.forename: Carlo Riccardo
authors.initials: CR
authors.lastname: Rossi
authors.affiliation: Division of Melanoma-Soft Tissues-Head and Neck, Department of Surgery, National Cancer Institute "Pascale," Naples, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Mozzillo
authors.affiliation: Melanoma and Sarcoma Unit, National Cancer Institute, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Maurichi
authors.affiliation: Surgery Branch, Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Pasquali
authors.affiliation: Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Macripò
authors.affiliation: Plastic Surgery Unit, Regional Melanoma Referral Center, Santa Maria Annunziata Hospital, Tuscan Tumor Institute, Florence, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Borgognoni
authors.affiliation: Division of Surgical Oncology, IRCC-San Martino Hospital-National Cancer Institute of Genoa, Genoa, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Solari
authors.affiliation: Unit of Surgery, Riuniti Hospital, Bergamo, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Piazzalunga
authors.affiliation: Unit of General Surgery, San Pio X Hospital, Milan, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Mascheroni
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Bari, Bari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Giudice
authors.affiliation: Surgery Branch, Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Mocellin
authors.affiliation: Melanoma and Sarcoma Unit, National Cancer Institute, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Patuzzo
authors.affiliation: Division of Melanoma-Soft Tissues-Head and Neck, Department of Surgery, National Cancer Institute "Pascale," Naples, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Caracò
authors.affiliation: Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Ribero
authors.affiliation: Division of Melanoma-Soft Tissues-Head and Neck, Department of Surgery, National Cancer Institute "Pascale," Naples, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: Marone
authors.affiliation: Melanoma and Sarcoma Unit, National Cancer Institute, Milan, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Santinami
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007558:Italy; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000556:secondary*; D008875:Middle Aged; D011379:Prognosis; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology*; D016896:Treatment Outcome; D000096142:Cutaneous Malignant Melanoma