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 the
American Society of Plastic and Reconstructive Surgeons (ASPRS)
held in Dallas, Texas. Although the retrospective study did not
demonstrate that ELND makes a difference in patient survival,
it indicated that the information gained from the removal and
testing of the lymph nodes could be crucial in predicting the
"Melanoma has clinical characteristics that require observation
over a long period of time for an accurate picture of what ultimately
will 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 curative
adjunct therapies beyond surgery do not currently exist, the main
value in looking at the lymph nodes probably is the prognostic
information that they provide for the patient. From this, we are
able 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 should
receive it based on a high-risk for recurrent disease."
Elective lymph node dissection is the removal of lymph nodes immediately
surrounding the melanoma and takes place at the same time as removal
of the tumor. If malignant cells are detected in the removed lymph
nodes, this has significant ramifications for the patient's prognosis.
The surgeon generally determines whether ELND will be included
with therapy based on factors inherent to the tumor and the patient.
The retrospective study included 424 patients with clinical stage
I melanoma of the head and neck treated at the Mayo Clinic for
the 20-year period between 1970 and 1990. In all, 42% (180) of
the patients underwent ELND as part of their initial treatment,
and testing revealed malignancy in the lymph nodes of 83%. Initial
treatment failed in 36% (152) of patients because of distant metastasis.
Although the study showed no survival or disease control benefit
for ELND, information resulting from tests of the removed lymph
nodes had significant prognostic value. The remarkable long-term
survival rates are likely due to early detection of the disease
in this particular group of patients, with 82% surviving after
5 years and 75% surviving after 10 years. No patients were known
to have died of their disease 15 years after initial treatment.
Ongoing multi-institutional prospective studies investigating
the therapeutic efficacy of ELND in treating melanoma are now
"Unfortunately, we now are seeing an unprecedented number
of people in their 20's with melanoma," said Dr. Kane. "There
is no question that the number of primary diagnosed cases in this
age group is on the rise and many of these are people who have
been going to tanning booths."
Some people have a genetic predisposition to melanoma, according
to Dr. Kane, and overexposure to ultraviolet light exacerbates
that problem. Melanoma can even occur in the sinus cavities and
under the tongue, places that sunlight never touches. However,
early detection and surgical removal is still the best treatment
for melanoma, and the prognosis for people whose disease is caught
early remains reasonably good.