Melanoma recurrence in a previously dissected lymph node basin.

OBJECTIVES: To retrospectively assess whether completeness of node dissection has any bearing on regional control in cutaneous melanoma and to examine the efficacy of a subsequent dissection in patients with isolated nodal recurrence.

DESIGN: Case series, 18-month minimum follow-up.

SETTING: Academic surgical practice.

STUDY PARTICIPANTS: Patients with cutaneous melanoma who had undergone a regional node dissection and subsequently developed recurrence in the same nodal basin in which a lymphadenectomy had been performed with no evidence of distant metastases. Of 1030 instances of regional node dissection, 28 met these criteria.

MAIN OUTCOME MEASURES: Nodal recurrence in the previously dissected lymph node basin as the only site of recurrence and survival following a subsequent lymph node dissection.

RESULTS: The 28 instances of isolated nodal recurrence represent a regional failure rate of 2.7%. In those cases where the first dissection was performed within our division, the rate is 0.8%. Recurrence for cervical, axillary, or inguinal sites was similar. In 71% of the cases, more than one node was positive at the time of recurrence. Four patients have shown disease-free survival greater than 3 years following a subsequent lymphadenectomy.

CONCLUSION: Node dissection is a therapeutic procedure and, therefore, must consist of complete lymphadenectomy with meticulous attention to surgical detail. Approached in this fashion, only a small subgroup of patients will show recurrence in a previously dissected nodal basin, a few of whom can be salvaged by a second dissection.