title: Frequency of level II and III axillary nodes metastases in patients with positive sentinel lymph nodes in melanoma: a multi-institutional study in Japan.
abstract: BACKGROUND
  Axillary lymph node dissection (ALND) has been recommended to include levels I-III for melanoma patients who have evidence of metastasis in the axillary sentinel lymph node (SLN). The extent of the subsequent axillary dissection is in debate. The objective of this study was to determine the frequency of metastasis of level III nodes in addition to that of level II nodes in this setting.
  
  
  METHODS
  A multi-institutional retrospective study was undertaken in 14 melanoma treatment centers in Japan.
  
  
  RESULTS
  Between 2007 and 2012, 69 patients with involved axillary SLNs underwent a subsequent ALND and 55 underwent level I and II dissections. Level III metastatic nodes, which is our primary endpoint, were seen in only 1 patient (1.5 %). The level II metastatic rate was 4.4 %.
  
  
  CONCLUSIONS
  Our study sample size was small, but melanoma patients with positive SLN rarely had level III disease, suggesting that level III dissection may be unnecessary. We also found that level II metastasis was not so frequent. More evidence is needed to standardize the extent of ALND and to identify the patients who would have the most benefit with undergoing level II dissection for positive axillary SLNs.
authors.affiliation: Department of Dermatologic Oncology, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo, 104-0045, Japan. atsutsum@ncc.go.jp.
authors.forename: Arata
authors.initials: A
authors.lastname: Tsutsumida
authors.affiliation: Department of Dermatologic Oncology, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo, 104-0045, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Takahashi
authors.affiliation: Department of Dermatologic Oncology, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo, 104-0045, Japan.
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Namikawa
authors.affiliation: Department of Dermatologic Oncology, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo, 104-0045, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Yamazaki
authors.affiliation: Department of Dermatology, Shinshu University, Matsumoto, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Uhara
authors.affiliation: Department of Skin Oncology and Dermatology, Saitama Medical University, International Medical Center, Hidaka, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Teramoto
authors.affiliation: Department of Dermatology, Niigata Cancer Center Hospital, Niigata, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Takenouchi
authors.affiliation: Department of Dermatology and Plastic Surgery, Kumamoto University, Kumamoto, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Fukushima
authors.affiliation: Department of Dermatology, Nagoya University, Nagoya, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yokota
authors.affiliation: Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Uehara
authors.affiliation: Department of Dermato-Oncology/Dermatology, Kagoshima Medical Center and Department of Dermatology, Kagoshima University, Kagoshima, Japan.
authors.forename: Shigeto
authors.initials: S
authors.lastname: Matsushita
authors.affiliation: Department of Dermatology, Fukuoka University, Fukuoka, Japan.
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Shibayama
authors.affiliation: Department of Dermatology, Toyama Prefectural Central Hospital, Toyama, Japan.
authors.forename: Naohito
authors.initials: N
authors.lastname: Hatta
authors.affiliation: Department of Dermatology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Masui
authors.affiliation: Department of Dermatology, Kyushu University, Fukuoka, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Uchi
authors.affiliation: Department of Dermatology, University of Tsukuba, Tsukuba, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujisawa
authors.affiliation: Department of Dermatology, Saitama Medical University, Moroyama, Japan.
authors.forename: Dai
authors.initials: D
authors.lastname: Ogata
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008297:Male; D008545:Melanoma / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D000071036:Sentinel Lymph Node / Q000473:pathology*; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome
keywords: Axilla; Lymph node dissection; Lymphadenectomy; Melanoma; Sentinel lymph node