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Surgical resection for bulky or recurrent axillary metastatic melanoma
Author(s) -
Shada Amber L.,
Walters Dustin M.,
Tierney Shan N.,
Slingluff Craig L.
Publication year - 2011
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.22058
Subject(s) - medicine , asymptomatic , surgery , stage (stratigraphy) , melanoma , lymphedema , axilla , neurovascular bundle , quality of life (healthcare) , breast cancer , cancer , paleontology , cancer research , biology , nursing
Metastatic melanoma has few FDA approved treatments, and aggressive surgical resection has to be considered for management of bulky axillary metastases. We hypothesized that axillary resection in this setting is well tolerated and improves symptoms in the majority of patients. Methods We reviewed a prospectively collected database and identified 47 stage IIIC and IV patients with axillary nodal disease greater than 5 cm (68%), recurrent disease (36%), or disease adherent to axillary neurovascular structures (45%). Paresthesias, pain, and bleeding were present in 40% of patients, and were stable or improved after surgery in 75%. Most patients were asymptomatic prior to resection, and underwent resection for prevention of potential symptoms. Results Most patients underwent outpatient surgery. Postoperative complications included lymphedema (34%), range of motion limitation (23%), wound infection (17%), and neuropathic pain (17%). Among symptomatic patients, average time to progression was 3 months, compared to 9.5 months in asymptomatic patients ( P = 0.08). Five‐year survival was lower (16%) in symptomatic patients than in asymptomatic patients (35%, P = 0.001). Discussion Surgery for bulky axillary melanoma metastases is well tolerated, and should be considered in the management of Stage III or IV melanoma. Resection prior to symptoms may improve quality of life and is associated with longer survival. J. Surg. Oncol. 2012; 105:21–25. © 2011 Wiley Periodicals, Inc.