Can Elective Lymph Node Dissection Decrease the Frequency and Mortality Rate of Late Melanoma Recurrences?

Shen, Perry; Guenther, J. Michael; Wanek, Leslie A.; Morton, Donald L.

doi:10.1007/s10434-000-0114-x

Cited by 34 publications

(24 citation statements)

References 16 publications

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“…Several studies could not justify a therapeutic effect from ELND, [5][6][7] whereas some demonstrated a survival benefit 8,9 and others demonstrated increased survival only in specific subgroups of patients who had undergone prophylactic regional lymph node dissection. 10 However no randomized studies have been conducted to date analyzing the therapeutic benefit of ELND in patients with T4 disease.…”

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confidence: 99%

Prognostic factors in patients with thick cutaneous melanoma (> 4 mm)

Zettersten

Sagebiel

Miller

et al. 2002

Cancer

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BACKGROUNDThe current study was conducted to examine the role of multiple clinical and histologic factors in the prognostic assessment of patients with thick primary melanoma (> 4 mm, classified as T4).METHODSA retrospective analysis was performed in 329 patients with T4 cutaneous melanomas who were seen at the University of California at San Francisco Melanoma Center between 1978 and 2000. Fourteen histopathologic features were recorded prospectively by a single dermatopathologist. In addition, 9 clinical factors were analyzed.RESULTSSeveral histologic factors were found to have a significant impact on the survival of patients with T4 melanoma. On univariate analysis, tumor thickness, ulceration, mitotic rate, microsatellites, vascular involvement, and histogenetic type of the primary tumor all were found to have a significant impact on the overall survival rate. Regional lymph node involvement reduced the overall survival of T4 patients dramatically. The 5‐year overall survival of patients with lymph node‐negative T4 disease was 61%, compared with 30% for those with lymph node‐positive disease. When lymph node status was taken into account, tumor thickness, vascular involvement, and ulceration all remained independent predictors of overall survival on multivariate Cox regression analysis. Neither age, gender, nor anatomic location appeared to affect the recurrence‐free or overall survival rates.CONCLUSIONSPatients with thick primary cutaneous melanomas (> 4 mm) comprise a heterogeneous group. The presence or absence of lymph node involvement, vascular involvement, and ulceration appears to result in significantly divergent overall survival rates in this patient cohort. Consideration of these factors has important implications in the management of patients with T4 melanoma. Cancer 2002;94:1049–56. © 2002 American Cancer Society.DOI 10.1002/cncr.10326

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confidence: 99%

Prognostic factors in patients with thick cutaneous melanoma (> 4 mm)

Zettersten

Sagebiel

Miller

et al. 2002

Cancer

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“…Diagnostic criteria include the distinction from MM mimics, especially atypical nevi, Spitz tumors, and lesions presenting asymmetry, border notching, color variegation, diameter of more than 5 mm, rapid onset or increase in diameter, as well as bleeding, ulceration, itching, and pain [7]. Proper surgical excision, appropriate use of staging techniques, such as SLNB, and ELND are important for correct management [8][9][10], but prevention is still the best strategy. Education about warning signs of melanoma, adequate sun protection, follow-up for clinical changing, the use of dermoscopy, and, according to many authors, removal of large (N20 cm) congenital melanocytic nevi play an important role in the prevention of MM, whereas the risks associated with medium and small congenital melanocytic nevi and their preventive excision are still a matter of controversy [5,6].…”

Section: Discussionmentioning

confidence: 99%

Indications for excision of nevi and melanoma diagnosed in a pediatric surgical unit

Zangari

Bernardini²,

Tallarico

et al. 2007

Journal of Pediatric Surgery

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“…According to Shen et al ., in primary cutaneous melanoma the mean disease-free interval after surgery was 182 months [14] whereas Briele et al ., report seven patients in whom local or regional recurrence occured 11 to 23 years after first treatment of melanoma [15]. Another neoplasm after a treatment of which long-term follow-up is essential is medulloblastoma as recurrences after the Collins' risk period (i.e.…”

Section: Discussionmentioning

confidence: 99%