BACKGROUND: Controversy exists regarding the value and indications for inguinal dissection alone or in combination with an iliac/obturator lymph node dissection for melanoma. STUDY DESIGN: We reviewed patients from a multicenter prospective clinical trial and a single center who underwent inguinal dissection alone or combined with an iliac/obturator dissection for cutaneous melanoma. Analyses were stratified and compared by microscopic or macroscopic (palpable or detected by imaging) disease. RESULTS: The study was composed of 134 patients with a median follow-up of 39 months. Indications for inguinal dissection were microscopic disease in 94 (70%) patients and macroscopic nodal disease in 40 (30%) patients. An iliac/obturator dissection yielded tumor-positive pelvic nodes in 25% vs 55% in the microscopic vs macroscopic groups, respectively (p = 0.10). No risk factors for positive pelvic nodes were identified. For both microscopic and macroscopic disease, addition of an iliac/obturator dissection to an inguinal dissection did not significantly reduce the risk of pelvic nodal recurrence. Five-year overall survival rates for 4 groups were compared: microscopic disease, inguinal dissection alone (72%); microscopic disease, iliac/obturator dissection (68%); macroscopic disease, inguinal dissection alone (51%); and macroscopic disease, iliac/obturator dissection (44%) (p = 0.0163). On survival analysis, addition of an iliac/obturator dissection in either microscopic or macroscopic disease did not affect disease-free survival or regional lymph node recurrence-free survival. CONCLUSIONS: The addition of an iliac/obturator dissection to an inguinal dissection for both microscopic and macroscopic nodal disease did not significantly affect lymph node recurrence rates, disease-free survival, or overall survival.
BACKGROUND: Controversy exists regarding the value and indications for inguinal dissection alone or in combination with an iliac/obturator lymph node dissection for melanoma. STUDY DESIGN: We reviewed patients from a multicenter prospective clinical trial and a single center who underwent inguinal dissection alone or combined with an iliac/obturator dissection for cutaneous melanoma. Analyses were stratified and compared by microscopic or macroscopic (palpable or detected by imaging) disease. RESULTS: The study was composed of 134 patients with a median follow-up of 39 months. Indications for inguinal dissection were microscopic disease in 94 (70%) patients and macroscopic nodal disease in 40 (30%) patients. An iliac/obturator dissection yielded tumor-positive pelvic nodes in 25% vs 55% in the microscopic vs macroscopic groups, respectively (p = 0.10). No risk factors for positive pelvic nodes were identified. For both microscopic and macroscopic disease, addition of an iliac/obturator dissection to an inguinal dissection did not significantly reduce the risk of pelvic nodal recurrence. Five-year overall survival rates for 4 groups were compared: microscopic disease, inguinal dissection alone (72%); microscopic disease, iliac/obturator dissection (68%); macroscopic disease, inguinal dissection alone (51%); and macroscopic disease, iliac/obturator dissection (44%) (p = 0.0163). On survival analysis, addition of an iliac/obturator dissection in either microscopic or macroscopic disease did not affect disease-free survival or regional lymph node recurrence-free survival. CONCLUSIONS: The addition of an iliac/obturator dissection to an inguinal dissection for both microscopic and macroscopic nodal disease did not significantly affect lymph node recurrence rates, disease-free survival, or overall survival.
Authors: John T Miura; Lesly A Dossett; Ram Thapa; Youngchul Kim; Aishwarya Potdar; Hala Daou; James Sun; Amod A Sarnaik; Jonathan S Zager Journal: Ann Surg Oncol Date: 2019-04-04 Impact factor: 5.344
Authors: James W Jakub; Alicia M Terando; Amod Sarnaik; Charlotte E Ariyan; Mark B Faries; Sabino Zani; Heather B Neuman; Nabil Wasif; Jeffrey M Farma; Bruce J Averbook; Karl Y Bilimoria; Travis E Grotz; Jacob B Jake Allred; Vera J Suman; Mary Sue Brady; Douglas Tyler; Jeffrey D Wayne; Heidi Nelson Journal: Ann Surg Date: 2017-01 Impact factor: 12.969
Authors: Lesly A Dossett; Nicholas B Castner; Julio M Pow-Sang; Andrea M Abbott; Vernon K Sondak; Amod A Sarnaik; Jonathan S Zager Journal: J Am Coll Surg Date: 2016-01-14 Impact factor: 6.113
Authors: Alexander C J van Akkooi; Tina J Hieken; Elizabeth M Burton; Andrew J Spillane; Merrick I Ross; Charlotte Ariyan; Paolo A Ascierto; Salvatore V M A Asero; Christian U Blank; Matthew S Block; Genevieve M Boland; Corrado Caraco; Sydney Chng; B Scott Davidson; Joao Pedreira Duprat Neto; Mark B Faries; Jeffrey E Gershenwald; Dirk J Grunhagen; David E Gyorki; Dale Han; Andrew J Hayes; Winan J van Houdt; Giorgos C Karakousis; Willem M C Klop; Georgina V Long; Michael C Lowe; Alexander M Menzies; Roger Olofsson Bagge; Thomas E Pennington; Piotr Rutkowski; Robyn P M Saw; Richard A Scolyer; Kerwin F Shannon; Vernon K Sondak; Hussein Tawbi; Alessandro A E Testori; Mike T Tetzlaff; John F Thompson; Jonathan S Zager; Charlotte L Zuur; Jennifer A Wargo Journal: Ann Surg Oncol Date: 2022-01-28 Impact factor: 5.344
Authors: Enrique Boldo; Araceli Mayol; Rafael Lozoya; Alba Coret; Diana Escribano; Carlos Fortea; Andres Muñoz; Juan Carlos Pastor; Guillermo Perez De Lucia Journal: Melanoma Manag Date: 2020-07-21
Authors: C M C Oude Ophuis; A C J van Akkooi; H J Hoekstra; J J Bonenkamp; J van Wissen; M G Niebling; J H W de Wilt; B van der Hiel; B van de Wiel; S Koljenović; D J Grünhagen; C Verhoef Journal: Ann Surg Oncol Date: 2015-05-27 Impact factor: 5.344
Authors: D Verver; M F Madu; C M C Oude Ophuis; M Faut; J H W de Wilt; J J Bonenkamp; D J Grünhagen; A C J van Akkooi; C Verhoef; B L van Leeuwen Journal: Br J Surg Date: 2017-11-02 Impact factor: 6.939
Authors: Mikko Vuoristo; Timo Muhonen; Virve Koljonen; Susanna Juteau; Micaela Hernberg; Suvi Ilmonen; Tiina Jahkola Journal: BJS Open Date: 2021-11-09