Patterns of relapse in 1001 consecutive patients with melanoma nodal metastases.

The impact of nodal tumor burden on patterns of relapse and survival was retrospectively analyzed in 1001 patients with stage III melanoma. The incidence of tumor recurrence within the node dissection field was lower in patients with 1 nodal metastasis (9%) or with no extranodal invasion (15%) than in patients with multiple involved nodes (15% to 33%) or connective tissue invasion (28%). Patients with 1 "positive" node (a node in which cancer was detected) had a 45% 5-year and 39% 10-year survival rate compared with patients who had 2 to 4 positive nodes (37% and 28%), 5 to 10 nodes (20% and 17%), more than 10 nodes (5% and 3%), or extranodal invasion (14% and 11%). The occurrence of in-transit metastases in 10% of patients after nodal dissection was not influenced by the extent of nodal tumor burden.