Premium
Indications for elective groin dissection in clinical stage I patients with malignant melanoma of the lower extremity treated by hyperthermic regional perfusion
Author(s) -
Martijn Hendrik,
Oldhoff Jan,
Oosterhuis J. Wolter,
Koops Heimen Schraffordt
Publication year - 1983
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19831015)52:8<1526::aid-cncr2820520832>3.0.co;2-j
Subject(s) - medicine , groin , sentinel node , melanoma , stage (stratigraphy) , dissection (medical) , biopsy , perfusion , surgery , radiology , cancer , breast cancer , paleontology , cancer research , biology
From 1973 through 1979, inguinal node biopsy was performed to stage the disease process in 179 clinical Stage I patients with malignant melanoma of the lower extremity, who were all treated by hyperthermic regional perfusion as well. Of the 179 tumors, 12% were intermediate risk (0.75–1.44 mm) and 88% were high risk (⩾1.5 mm); all had a Clark level of IV or V. The Rosenmüller node at the caudal margin of the saphenous hiatus was elected for inguinal node biopsy. This biopsy supplies a fair amount of information about the entire inguinal node region: a malignant node was found in 16 patients (9%); no other metastatic nodes were found in 11 (73%) of 15 subsequent therapeutic node dissections; the 16th had metastatic parailiac nodes as well. Two patients of the remaining 163 had only metastatic parailiac nodes, without metastatic inguinal nodes. Of the remaining 161 histologic Stage I patients, 23 (14%) developed inguinal node metastases in the course of the follow‐up. In 17 (74%) these metastases occurred within 2 years of perfusion. Ten of the 23 showed simultaneous general metastases. The vast majority of the inguinal node metastases developed in patients with a tumor ⩾5 mm. The 5‐year survival was 81%, i.e. 84% in females versus 69% in males, the difference being significant ( P < 0.01). A tumor thickness ⩾5 mm implied a significantly less favorable prognosis as to development of inguinal node metastases associated with general metastases than a tumor thickness < 5 mm. The benefit of the inguinal node biopsy was related to the difference in 5‐year survival between the group with inguinal node metastases at perfusion (69%) and the group who developed inguinal node metastases during the follow‐up (24%). The difference was great (45%) but statistically not significant. The data seem to warrant the conclusion that, after perfusion therapy, inguinal node biopsy is sufficient to stage the disease process at a tumor thickness ⩾5 mm. Given a tumor thickness ⩾5 mm, elective groin dissection might improve the chance of survival.