Lymph Node Removal May Provide Prognostic Information for Melanoma Patients

A controversial treatment for melanoma, elective lymph node dissection(ELND), has again been shown to provide important prognostic information,according to a study presented at the 65th Annual Meeting of theAmerican Society of Plastic and Reconstructive Surgeons (ASPRS)held in Dallas, Texas. Although the retrospective study did notdemonstrate that ELND makes a difference in patient survival,it indicated that the information gained from the removal andtesting of the lymph nodes could be crucial in predicting thepatient's prognosis.

"Melanoma has clinical characteristics that require observationover a long period of time for an accurate picture of what ultimatelywill happen to patients," said plastic surgeon William J.Kane, md, assistant professor of plastic and reconstructive surgery,Mayo Graduate School of Medicine, Mayo Clinic, Rochester, Minnesota,one of the clinical investigators. "Since reliable curativeadjunct therapies beyond surgery do not currently exist, the mainvalue in looking at the lymph nodes probably is the prognosticinformation that they provide for the patient. From this, we areable to determine how well the patient will do in the future.Once more reliable immune or chemotherapeutic therapies are developed,this information may have value in deciding which patients shouldreceive it based on a high-risk for recurrent disease."

Elective lymph node dissection is the removal of lymph nodes immediatelysurrounding the melanoma and takes place at the same time as removalof the tumor. If malignant cells are detected in the removed lymphnodes, this has significant ramifications for the patient's prognosis.The surgeon generally determines whether ELND will be includedwith therapy based on factors inherent to the tumor and the patient.

The retrospective study included 424 patients with clinical stageI melanoma of the head and neck treated at the Mayo Clinic forthe 20-year period between 1970 and 1990. In all, 42% (180) ofthe patients underwent ELND as part of their initial treatment,and testing revealed malignancy in the lymph nodes of 83%. Initialtreatment failed in 36% (152) of patients because of distant metastasis.

Although the study showed no survival or disease control benefitfor ELND, information resulting from tests of the removed lymphnodes had significant prognostic value. The remarkable long-termsurvival rates are likely due to early detection of the diseasein this particular group of patients, with 82% surviving after5 years and 75% surviving after 10 years. No patients were knownto have died of their disease 15 years after initial treatment.Ongoing multi-institutional prospective studies investigatingthe therapeutic efficacy of ELND in treating melanoma are nowunderway.

"Unfortunately, we now are seeing an unprecedented numberof people in their 20's with melanoma," said Dr. Kane. "Thereis no question that the number of primary diagnosed cases in thisage group is on the rise and many of these are people who havebeen going to tanning booths."

Some people have a genetic predisposition to melanoma, accordingto Dr. Kane, and overexposure to ultraviolet light exacerbatesthat problem. Melanoma can even occur in the sinus cavities andunder the tongue, places that sunlight never touches. However,early detection and surgical removal is still the best treatmentfor melanoma, and the prognosis for people whose disease is caughtearly remains reasonably good.