Sentinel node biopsy and radical lymph node dissection for advanced melanoma in the elderly
© Desiato et al; licensee BioMed Central Ltd. 2011
Published: 24 August 2011
The majority of indications for surgery in melanoma are for the treatment of primary tumor and lymph node metastases. During the last decade, the Sentinel Node Biopsy (SNB), from a research procedure, has become standard of care in most institutions. SNB is normally considered for patients with melanoma > 1 mm and generally about 20% are positive; however, the risk of a positive SNB in a melanoma < 1 mm is still 5%. Usually when SNB is positive a complete lymphadenectomy is performed.
Materials and methods
In the period 2004-2009, 18 elderly patients (median age 68 years) affected by cutaneous melanoma (mean Breslow’s thickness = 3.77 mm), after SNB histologically confirmed regional lymph node involvement, underwent complete lymph node dissection (CLND). We treated 11 of them with groin dissection, in 3 cases bilateral; 4 patients underwent axillar dissection, in one case bilateral; 2 patients underwent neck dissection and another patient underwent groin-axillar dissection. We treated bilateral groin involvement with laparoscopic access for dissection of lumbar-aortic, iliac and obturator lymph nodes.
Disagreeing with literature, 12/18 (67%) of these patients had positive lymph nodes, a high percentage if compared with younger patients’ data. Currently the average follow-up is 25 months. In our sample CLND has a crucial prognostic role (16% vs 41% of deceased in CLND – and CLND + patients respectively).
Elderly melanoma patients are characterized by a higher tumor stage and, in patients with nodal metastases, the prognosis is independently affected by older age. In case of positive SNB the CLND plays a notable prognostic role and a presumable therapeutic role.
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