Abstract
Background: Although more than 90% of the morbidity and mortality from localized cutaneous melanoma occurs in the first decade after initial surgical treatment, melanoma can recur after a 10-year disease-free interval (DFI) with fatal consequences. We reviewed our melanoma data base of more than 8500 prospectively acquired patients to identify clinicopathological factors that affect the type, rate of occurrence, and outcome of disease recurring 10 years or more after surgical treatment of primary cutaneous melanoma.
Methods: From 1971 to 1997, 1907 melanoma patients treated at our cancer center reached or presented with a DFI of 10 years or more after surgical treatment of clinically localized melanoma. Of these, 217 (11%) patients had recurrences (mean DFI, 182 months). The sites of recurrence were local/in-transit in 26 (12%) patients, regional lymph nodes in 101 (47%) patients, and distant sites in 90 (41%) patients.
Results: Univariate and multivariate analysis, using patient age and sex, type of initial treatment, and the site, Breslow thickness, and Clark level of the initial tumor, showed that the type of treatment for the primary tumor was a significant (P = .0005) prognostic factor in the development of late nodal recurrence. Of the 217 patients who had recurrences, 172 (79%) had undergone wide local excision for their primary melanoma, and 45 (21%) had undergone wide local excision plus elective lymph node dissection (ELND). The rates of nodal recurrence were 53% (92 of 172) and 20% (9 of 45), respectively, a significant (P = .0001) difference. When all patients with a DFI of 10 years or more were stratified by type of initial treatment, the ELND group demonstrated a significant improvement in disease-free survival and overall survival.
Conclusions: The risk of late-recurring nodal disease increases and the chance of long-term survival decreases when wide local excision is performed without ELND. With the advent of sentinel lymphadenectomy, ELND can be selectively performed only for those nodal basins with occult tumor cells, thereby decreasing operative morbidity but allowing identification and early removal of nodal micrometastases.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Epstein E, Bragg AK. Curability of melanoma: a 25-year retrospective study. Cancer 1980;46:818–821.
Callaway MP, Briggs JC. The incidence of late recurrence (greater than 10 years): an analysis of 536 consecutive cases of cutaneous melanoma. Br J Surg 1989;42:46–49.
Levy E, Silverman MK, Vossaert KA. Late recurrence of malignant melanoma: a report of five cases, a review of the literature and a study of associated factors. Melanoma Res 1991;1:63–67.
Schultz S, Kane M, Roush R, et al. Time to recurrence varies inversely with thickness in clinical stage I cutaneous melanoma. Surg Gynecol Obstet 1990;171:393–397.
Shaw HM, Beattie CW, McCarthy WH, Milton GW. Late relapse from cutaneous stage I malignant melanoma. Arch Surg 1985;120:1155–1159.
Briele HA, Beattie CW, Ronan SG, Chandhuri PK, Das Gupta TK. Late recurrence of cutaneous melanoma. Arch Surg 1983;118:800–803.
Cascinelli N, Morabito A, Bufalino R, et al. Prognosis of stage I melanoma of the skin. Int J Cancer 1980;26:733–739.
Balch CM, Murad TM, Soong SJ, Ingalls AL, Halpern NB, Maddox WA. A multifactorial analysis of melanoma: prognostic and histopathological features comparing Clark’s and Breslow staging methods. Ann Surg 1978;188:732–742.
Day CL Jr, Sober AJ, Kopf AW. A prognostic model for clinical stage I melanoma of the upper extremity: the importance of anatomic subsites in predicting recurrent disease. Ann Surg 1981;193:436–440.
Yarnold JR, Cochrane JP. Malignant melanoma: significance of disease-free interval. Br J Radiol 1980;53:1068–1070.
O’Donnell M, Silove D, Wakefield D. Current perspectives on immunology and psychiatry. Aust N Z J Psychiatry 1988;22:366–382.
Morton DL, Wen D-R, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992;127:392–399.
Cascinelli N, Morabito A, Santinami M, MacKie RM, Belli F. Immediate or delayed dissection of regional nodes in patients with melanoma of the trunk: a randomised trial. WHO Melanoma Programme. Lancet 1998;351:793–796.
Balch CM, Ross M, Soong S-J, Harrison R. Long-term results of a prospective, randomized trial involving elective regional lymph node dissection in patients with intermediate thickness melanomas. Ann Surg Oncol 2000;7:87–97.
DeVita VT, Hellman S, Rosenberg SA. Cancer: Principles & Practice of Oncology. Philadelphia: Lippincott-Raven, 1997.
Crowley NJ, Seigler HF. Late recurrence of malignant melanoma. Ann Surg 1990;212:173–177.
Tsao H, Cosimi AB, Sober AJ Ultra-late recurrence (15 years or longer) of cutaneous melanoma. Cancer 1997;79:2361–2370.
Gershenwald JE, Thompson W, Mansfield PF, et al. Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients. J Clin Oncol 1999;17:976–983.
Essner R, Conforti A, Kelley MC, et al. Efficacy of lymphatic mapping, sentinel lymphadenectomy, and selective complete lymph node dissection as a therapeutic procedure for early-stage melanoma. Ann Surg Oncol 1999;6:442–449.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Shen, P., Guenther, J.M., Wanek, L.A. et al. Can Elective Lymph Node Dissection Decrease the Frequency and Mortality Rate of Late Melanoma Recurrences?. Ann Surg Oncol 7, 114–119 (2000). https://doi.org/10.1007/s10434-000-0114-x
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s10434-000-0114-x