title: Axillary Lymph Node Metastases of Melanoma: Management of Third-level Nodes.
abstract: OBJECTIVE
  To state the limits of axillary lymphadenectomy in patients with metastatic melanoma.
  
  
  METHODS
  We performed a prospective study on patients submitted to axillary dissection for stage III melanoma. At surgery, the third-level nodes were separately dissected to be examined by the pathologist.
  
  
  RESULTS
  We analyzed 86 patients. In 93%, the third-level nodes were disease-free; none of the patients with previous positive sentinel nodes (SN) showed nodal metastases at level III. Patients (7%) found to have positive level III nodes had undergone therapeutic lymphadenectomy for bulky nodal disease.
  
  
  CONCLUSIONS
  Our data show that axillary non-sentinel nodes of level III are usually disease-free in cases of previously positive SN, while they can be involved in the presence of bulky disease. A prerequisite allowing sparing of level III nodes after a positive SN biopsy is the meticulous research of all level I and II lymph nodes.
authors.affiliation: Department of Surgery, St. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Gentile
authors.affiliation: Department of Surgery, St. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy piero.covarelli@unipg.it.
authors.forename: Piero
authors.initials: P
authors.lastname: Covarelli
authors.affiliation: Institute of Surgical Dermatology, Health and Science City Hospital, University of Turin, Turin, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Picciotto
authors.affiliation: Institute of Surgical Dermatology, Health and Science City Hospital, University of Turin, Turin, Italy.
authors.forename: Virginia
authors.initials: V
authors.lastname: Caliendo
authors.affiliation: Clinical, Allergological and Venereological Section, Department of Medicine, University of Perugia, Perugia, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Stingeni
authors.affiliation: Section of Pathological Anatomy and Histology, Department of Experimental Medicine, University of Perugia, Perugia, Italy.
authors.forename: Rachele
authors.initials: R
authors.lastname: Del Sordo
authors.affiliation: Department of Surgery, St. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rulli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D019468:Disease Management; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: Melanoma; axilla; lymphatic dissection; surgery