title: International multi-institutional management and outcome of melanoma patients with positive sentinel lymph nodes in more than one nodal basin.
abstract: BACKGROUND
  Melanoma patients with palpable nodal disease in more than one basin have a worse prognosis than those with single-basin disease. Little is known about the outcome of patients with microscopically positive nodal disease in more than one basin, or how they are currently managed at tertiary referral centers.
  
  
  METHODS
  We identified 97 patients with positive sentinel lymph nodes (SLNs) in more than one lymph node basin from 1994 to 2010 from three tertiary care centers. Clinical and pathologic outcome variables were analyzed.
  
  
  RESULTS
  Ninety-seven patients (72 men, 25 women) were identified with at least one positive SLN in at least two node basins. Most primary tumors were truncal (68, 70 %) followed by extremity (16, 17 %) and head/neck (13, 13 %). The median Breslow depth was 3.2 mm (range 0.8-12 mm), and 49 (51 %) were ulcerated. The most frequently involved nodal basins were the axilla (112, 57 %), neck (40, 20 %), and groin (24, 12 %). Seventy-seven percent (153 of 198) of all positive SLN basins underwent completion lymph node dissection (CLND). Most patients (54, 56 %) developed recurrent disease, with a median time to recurrence of 20 months. The majority of first recurrences were distant (42, 43 %), followed by regional nonnodal metastases (17, 18 %) and regional nodal metastases (16, 16 %). There was no significant difference in median overall survival between CLND versus no-CLND groups (45 vs. 30 months, respectively).
  
  
  CONCLUSIONS
  Most melanoma patients with more than one SLN-positive basin are currently managed with CLND. Outcomes after CLND and no CLND are similarly poor; therefore, consideration of close nodal observation may be more appropriate.
authors: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors: Laleh G
authors: LG
authors: Melstrom
authors: Eletha
authors: E
authors: Taylor
authors: Deborah
authors: D
authors: Kuk
authors: Timothy L
authors: TL
authors: Frankel
authors: Katherine
authors: K
authors: Panageas
authors: Lauren
authors: L
authors: Haydu
authors: Michael S
authors: MS
authors: Sabel
authors: John F
authors: JF
authors: Thompson
authors: Charlotte
authors: C
authors: Ariyan
authors: Daniel G
authors: DG
authors: Coit
authors: Mary S
authors: MS
authors: Brady
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007390:International Agencies; D008197:Lymph Node Excision / Q000401:mortality*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D015996:Survival Rate; D055815:Young Adult