Arata Tsutsumida1, Akira Takahashi2, Kenjiro Namikawa2, Naoya Yamazaki2, Hisashi Uhara3, Yukiko Teramoto4, Tatsuya Takenouchi5, Satoshi Fukushima6, Kenji Yokota7, Jiro Uehara8, Shigeto Matsushita9, Yoshitsugu Shibayama10, Naohito Hatta11, Yuri Masui12, Hiroshi Uchi13, Yasuhiro Fujisawa14, Dai Ogata15. 1. Department of Dermatologic Oncology, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo, 104-0045, Japan. atsutsum@ncc.go.jp. 2. Department of Dermatologic Oncology, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo, 104-0045, Japan. 3. Department of Dermatology, Shinshu University, Matsumoto, Japan. 4. Department of Skin Oncology and Dermatology, Saitama Medical University, International Medical Center, Hidaka, Japan. 5. Department of Dermatology, Niigata Cancer Center Hospital, Niigata, Japan. 6. Department of Dermatology and Plastic Surgery, Kumamoto University, Kumamoto, Japan. 7. Department of Dermatology, Nagoya University, Nagoya, Japan. 8. Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan. 9. Department of Dermato-Oncology/Dermatology, Kagoshima Medical Center and Department of Dermatology, Kagoshima University, Kagoshima, Japan. 10. Department of Dermatology, Fukuoka University, Fukuoka, Japan. 11. Department of Dermatology, Toyama Prefectural Central Hospital, Toyama, Japan. 12. Department of Dermatology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan. 13. Department of Dermatology, Kyushu University, Fukuoka, Japan. 14. Department of Dermatology, University of Tsukuba, Tsukuba, Japan. 15. Department of Dermatology, Saitama Medical University, Moroyama, Japan.
Abstract
BACKGROUND: Axillary lymph node dissection (ALND) has been recommended to include levels I-III for melanoma patients who have evidence of metastasis in the axillary sentinel lymph node (SLN). The extent of the subsequent axillary dissection is in debate. The objective of this study was to determine the frequency of metastasis of level III nodes in addition to that of level II nodes in this setting. METHODS: A multi-institutional retrospective study was undertaken in 14 melanoma treatment centers in Japan. RESULTS: Between 2007 and 2012, 69 patients with involved axillary SLNs underwent a subsequent ALND and 55 underwent level I and II dissections. Level III metastatic nodes, which is our primary endpoint, were seen in only 1 patient (1.5 %). The level II metastatic rate was 4.4 %. CONCLUSIONS: Our study sample size was small, but melanoma patients with positive SLN rarely had level III disease, suggesting that level III dissection may be unnecessary. We also found that level II metastasis was not so frequent. More evidence is needed to standardize the extent of ALND and to identify the patients who would have the most benefit with undergoing level II dissection for positive axillary SLNs.
BACKGROUND: Axillary lymph node dissection (ALND) has been recommended to include levels I-III for melanomapatients who have evidence of metastasis in the axillary sentinel lymph node (SLN). The extent of the subsequent axillary dissection is in debate. The objective of this study was to determine the frequency of metastasis of level III nodes in addition to that of level II nodes in this setting. METHODS: A multi-institutional retrospective study was undertaken in 14 melanoma treatment centers in Japan. RESULTS: Between 2007 and 2012, 69 patients with involved axillary SLNs underwent a subsequent ALND and 55 underwent level I and II dissections. Level III metastatic nodes, which is our primary endpoint, were seen in only 1 patient (1.5 %). The level II metastatic rate was 4.4 %. CONCLUSIONS: Our study sample size was small, but melanomapatients with positive SLN rarely had level III disease, suggesting that level III dissection may be unnecessary. We also found that level II metastasis was not so frequent. More evidence is needed to standardize the extent of ALND and to identify the patients who would have the most benefit with undergoing level II dissection for positive axillary SLNs.
Authors: Sigrid M C Broekaert; Ritu Roy; Ichiro Okamoto; Joost van den Oord; Jürgen Bauer; Claus Garbe; Raymond L Barnhill; Klaus J Busam; Alistair J Cochran; Martin G Cook; David E Elder; Stanley W McCarthy; Martin C Mihm; Dirk Schadendorf; Richard A Scolyer; Alan Spatz; Boris C Bastian Journal: Pigment Cell Melanoma Res Date: 2010-12 Impact factor: 4.693
Authors: John A Curtin; Jane Fridlyand; Toshiro Kageshita; Hetal N Patel; Klaus J Busam; Heinz Kutzner; Kwang-Hyun Cho; Setsuya Aiba; Eva-Bettina Bröcker; Philip E LeBoit; Dan Pinkel; Boris C Bastian Journal: N Engl J Med Date: 2005-11-17 Impact factor: 91.245
Authors: Jukes P Namm; Alfred E Chang; Vincent M Cimmino; Riley S Rees; Timothy M Johnson; Michael S Sabel Journal: J Surg Oncol Date: 2011-08-22 Impact factor: 3.454
Authors: Donald L Morton; John F Thompson; Alistair J Cochran; Nicola Mozzillo; Omgo E Nieweg; Daniel F Roses; Harold J Hoekstra; Constantine P Karakousis; Christopher A Puleo; Brendon J Coventry; Mohammed Kashani-Sabet; B Mark Smithers; Eberhard Paul; William G Kraybill; J Gregory McKinnon; He-Jing Wang; Robert Elashoff; Mark B Faries Journal: N Engl J Med Date: 2014-02-13 Impact factor: 91.245