Superficial Inguinal and Radical Ilioinguinal Lymph Node Dissection in Patients with Palpable Melanoma Metastases to the Groin - An Analysis of Survival and Local Recurrence

Abstract

The present study addresses the question whether an extended ilioinguinal dissection as compared to an only superficial inguinal dissection improves survival and/or local tumour control after the appearance of palpable melanoma metastases to the groin. We retrospectively analysed the data of 104 patients with 69 ilioinguinal and 35 superficial inguinal dissections (median follow up 127 months). Prognostic factors of survival and groin recurrence were assessed using Kaplan-Meier estimation and Cox proportional hazards model. By multifactorial analysis, metastatic involvement of two lymph nodes or less was associated with a significantly better survival rate than involvement of > 2 or pelvic nodes (p = 0.0002). After radical ilioinguinal dissection, patients with extremity-located primaries had a better prognosis than patients with truncal primaries (p = 0.03). Tumour infiltration of the ilio-obturator compartment was found to be an independent factor of poor prognosis (p = 0.0009). The probability of recurrence in the dissected groin paralleled the number of positive nodes and significantly increased if intransits were observed (p = 0.0002). The extent of surgery, Breslow thickness, epidermal ulceration, sex, age and adjuvant chemotherapy neither significantly influenced survival nor local control rates. In summary, when metastatic inguinal nodes become palpable, the presence of pelvic metastases indicates systemic disease. After therapeutic groin dissection, local recurrence and survival depend rather on regional tumour burden than on the extent of surgery.

Regional Control and Morbidity After Superficial Groin Dissection in Melanoma

“…6,12,13,20 (Table 4) Like other published studies, we found that number of positive nodes and extracapsular extension are better predictors of poor outcome than palpable tumor burden in the groin. 20–22 Thus, even in patients with palpable disease, SGD is appropriate for clearance of lymph nodes from the groin. The obvious caveat to this is that patients must be evaluated preoperatively and have no evidence of iliac metastases prior to SGD.…”

“…However, overall recurrence rate was 33.6%, and the fact that the study evaluated palpable disease may factor into that rate. 20 The current study included patients with palpable disease and did not see as high a rate of local recurrence after SGD. Perhaps our use of preoperative evaluation to exclude patients with iliac disease produced a patient population with lower overall regional disease burden.…”

Therapeutic Surgical Management of Palpable Melanoma Groin Metastases: Superficial or Combined Superficial and Deep Groin Lymph Node Dissection

“…Even comparison of patients with superficial involved nodes only showed no difference, indicating that the extent of groin surgery does not influence outcome (data not shown; p  = 0.217). Also in other studies, it has been demonstrated that extent of groin surgery, regardless of presence or absence of deep lymph node involvement in CGD patients, has no effect on survival 8,10,16…”

“…Also 5-year DFS rates were virtually identical, i.e., 18% for CGD and 16% for SGD. Patients with CGD with positive deep nodes have the poorest prognosis, with OS ranging from 6% to 34% in the literature 7,8,10,14–16. (Table 5).…”

Individualized Surgery: Gamma-Probe-Guided Lymphadenectomy in Patients with Clinically Enlarged Lymph Node Metastases from Melanomas

“…Well-established standard surgical techniques of TLND were considered as standard of care (modified neck dissection, axillary dissection including nodal levels I–III with preservation of the pectoralis minor muscle, ilioinguinal dissection). Our surgical approaches of TLND have been previously described 8,9. An abdominoperineal rectum extirpation along with the enlarged paraproctic node metastases was performed on one patient.…”