ORLANDOTen-year survival results from a major intergroup
study support the use of elective (immediate) regional lymph node
dissection (ELND) rather than watchful waiting for patients with
intermediate-thickness melanomas (1 to 4 mm).
Charles M. Balch, MD, of the University of Southern California,
reported the results at the Society of Surgical Oncologys 52nd
Annual Cancer Symposium, on behalf of the Intergroup Melanoma
The prospective, randomized trial included 740 stage I or II melanoma
patients (no regional lymph node metastases). Eligible patients were
stratified according to tumor thickness, anatomic site, and
ulceration, and then randomized to either elective lymph node
dissection or nodal observation. Median follow-up was 9 years
(maximum, 15 years).
This trial was designed with the understanding that not all
node-negative melanoma patients benefit from node dissection,
Dr. Balch said. The debate was whether prognostic factors could
identify subgroups for whom a node dissection could be therapeutic.
The focus was on patients with intermediate-thickness melanomas, who
are at high risk for regional disease and low risk for distant
disease at the time of diagnosis.
Overall 10-year survival was not significantly different for patients
who received elective lymph node dissection or nodal observation (77%
vs 72%; P = .09). However, node dissection did provide survival
benefits for several subgroups of patients. The increases in 10-year
survival for specific groups were as follows:
From 77% to 84% for patients with nonulcerative melanomas (P = .036)
From 79% to 86% for patients with tumor thickness of 1 to 2 mm (P = .038)
From 73% to 81% for patients 60 years of age or younger (P = .01)
From 81% to 94% for patients with tumors 1 to 2 mm thick and no
ulceration (P = .003)
This is the first trial to definitively demonstrate a
survival benefit for surgical removal of regional metastases of
melanoma, Dr. Balch said. These 10-year follow-up data
demonstrated even more strongly than previously reported 5-year data
that prospectively defined groups of patients with
intermediate-thickness melanomas, especially those with
nonulcer-ative melanomas and those with tumors 1 to 2 mm thick, have
a significant survival benefit from node dissection.