Can surgical therapy alone achieve long-term cure of melanoma metastatic to regional nodes?

Shawn E. Young, Steve R. Martinez, Mark B. Faries, Richard Essner, Leslie A. Wanek, Donald L. Morton

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

BACKGROUND: Anecdotal reports of melanoma recurrence 15 years after complete lymphadenectomy have led to claims that the onset of nodal metastasis invariably signals systemic metastases and a terminal diagnosis. Few series in the literature are able to refute this assertion. We therefore examined rates of long-term (> 15-25 years) survival for patients with regional (nodal) melanoma. PATIENTS AND METHODS: We performed an analysis of patients with American Joint Committee on Cancer stage III melanoma entered into a prospective database for the last 30 years. All patients were seen at the treating institution within 4 months of their diagnosis and monitored thereafter. All patients underwent complete lymphadenectomy. Patients receiving melanoma vaccines were excluded. Statistical comparisons used Chisquare analysis and the log-rank test. RESULTS: At a maximum follow up of 386 months (32 years) for the population of 1422 patients, rates of 15-, 20-, and 25-year melanoma-specific survival were 36% ± 1%, 35% ± 1%, and 35% ± 1%, respectively. When patients were stratified by clinical status of regional lymph nodes, survival rates were significantly lower (P = 0.001) if nodes were palpable. The number of tumor-positive nodes (P < 0.0001), the pathological primary tumor stage (P = 0.005), age (P = 0.0001), and gender (P = 0.002) also were significantly related to long-term survival. DISCUSSION: Long-term survivors of melanoma metastatic to regional lymph nodes are not uncommon, and the extremely low rate of recurrence beyond 15 years suggests that this disease-free interval is usually synonymous with cure. Although some risk factors decrease the likelihood of long-term survival, the high overall rates of extended survival in all risk groups clearly support surgical management as the primary treatment for regional metastatic melanoma.

Original languageEnglish (US)
Pages (from-to)207-211
Number of pages5
JournalCancer Journal
Volume12
Issue number3
DOIs
StatePublished - 2006
Externally publishedYes

Fingerprint

Melanoma
Survival
Lymph Node Excision
Therapeutics
Survival Rate
Lymph Nodes
Neoplasm Metastasis
Recurrence
Neoplasms
Survivors
Vaccines
Databases
Population

Keywords

  • Lymph node
  • Lymphadenectomy
  • Melanoma
  • Metastasis
  • Stage III
  • Surgery
  • Survival

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Young, S. E., Martinez, S. R., Faries, M. B., Essner, R., Wanek, L. A., & Morton, D. L. (2006). Can surgical therapy alone achieve long-term cure of melanoma metastatic to regional nodes? Cancer Journal, 12(3), 207-211. https://doi.org/10.1097/00130404-200605000-00009

Can surgical therapy alone achieve long-term cure of melanoma metastatic to regional nodes? / Young, Shawn E.; Martinez, Steve R.; Faries, Mark B.; Essner, Richard; Wanek, Leslie A.; Morton, Donald L.

In: Cancer Journal, Vol. 12, No. 3, 2006, p. 207-211.

Research output: Contribution to journalArticle

Young, SE, Martinez, SR, Faries, MB, Essner, R, Wanek, LA & Morton, DL 2006, 'Can surgical therapy alone achieve long-term cure of melanoma metastatic to regional nodes?', Cancer Journal, vol. 12, no. 3, pp. 207-211. https://doi.org/10.1097/00130404-200605000-00009
Young, Shawn E. ; Martinez, Steve R. ; Faries, Mark B. ; Essner, Richard ; Wanek, Leslie A. ; Morton, Donald L. / Can surgical therapy alone achieve long-term cure of melanoma metastatic to regional nodes?. In: Cancer Journal. 2006 ; Vol. 12, No. 3. pp. 207-211.
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abstract = "BACKGROUND: Anecdotal reports of melanoma recurrence 15 years after complete lymphadenectomy have led to claims that the onset of nodal metastasis invariably signals systemic metastases and a terminal diagnosis. Few series in the literature are able to refute this assertion. We therefore examined rates of long-term (> 15-25 years) survival for patients with regional (nodal) melanoma. PATIENTS AND METHODS: We performed an analysis of patients with American Joint Committee on Cancer stage III melanoma entered into a prospective database for the last 30 years. All patients were seen at the treating institution within 4 months of their diagnosis and monitored thereafter. All patients underwent complete lymphadenectomy. Patients receiving melanoma vaccines were excluded. Statistical comparisons used Chisquare analysis and the log-rank test. RESULTS: At a maximum follow up of 386 months (32 years) for the population of 1422 patients, rates of 15-, 20-, and 25-year melanoma-specific survival were 36{\%} ± 1{\%}, 35{\%} ± 1{\%}, and 35{\%} ± 1{\%}, respectively. When patients were stratified by clinical status of regional lymph nodes, survival rates were significantly lower (P = 0.001) if nodes were palpable. The number of tumor-positive nodes (P < 0.0001), the pathological primary tumor stage (P = 0.005), age (P = 0.0001), and gender (P = 0.002) also were significantly related to long-term survival. DISCUSSION: Long-term survivors of melanoma metastatic to regional lymph nodes are not uncommon, and the extremely low rate of recurrence beyond 15 years suggests that this disease-free interval is usually synonymous with cure. Although some risk factors decrease the likelihood of long-term survival, the high overall rates of extended survival in all risk groups clearly support surgical management as the primary treatment for regional metastatic melanoma.",
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AU - Young, Shawn E.

AU - Martinez, Steve R.

AU - Faries, Mark B.

AU - Essner, Richard

AU - Wanek, Leslie A.

AU - Morton, Donald L.

PY - 2006

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N2 - BACKGROUND: Anecdotal reports of melanoma recurrence 15 years after complete lymphadenectomy have led to claims that the onset of nodal metastasis invariably signals systemic metastases and a terminal diagnosis. Few series in the literature are able to refute this assertion. We therefore examined rates of long-term (> 15-25 years) survival for patients with regional (nodal) melanoma. PATIENTS AND METHODS: We performed an analysis of patients with American Joint Committee on Cancer stage III melanoma entered into a prospective database for the last 30 years. All patients were seen at the treating institution within 4 months of their diagnosis and monitored thereafter. All patients underwent complete lymphadenectomy. Patients receiving melanoma vaccines were excluded. Statistical comparisons used Chisquare analysis and the log-rank test. RESULTS: At a maximum follow up of 386 months (32 years) for the population of 1422 patients, rates of 15-, 20-, and 25-year melanoma-specific survival were 36% ± 1%, 35% ± 1%, and 35% ± 1%, respectively. When patients were stratified by clinical status of regional lymph nodes, survival rates were significantly lower (P = 0.001) if nodes were palpable. The number of tumor-positive nodes (P < 0.0001), the pathological primary tumor stage (P = 0.005), age (P = 0.0001), and gender (P = 0.002) also were significantly related to long-term survival. DISCUSSION: Long-term survivors of melanoma metastatic to regional lymph nodes are not uncommon, and the extremely low rate of recurrence beyond 15 years suggests that this disease-free interval is usually synonymous with cure. Although some risk factors decrease the likelihood of long-term survival, the high overall rates of extended survival in all risk groups clearly support surgical management as the primary treatment for regional metastatic melanoma.

AB - BACKGROUND: Anecdotal reports of melanoma recurrence 15 years after complete lymphadenectomy have led to claims that the onset of nodal metastasis invariably signals systemic metastases and a terminal diagnosis. Few series in the literature are able to refute this assertion. We therefore examined rates of long-term (> 15-25 years) survival for patients with regional (nodal) melanoma. PATIENTS AND METHODS: We performed an analysis of patients with American Joint Committee on Cancer stage III melanoma entered into a prospective database for the last 30 years. All patients were seen at the treating institution within 4 months of their diagnosis and monitored thereafter. All patients underwent complete lymphadenectomy. Patients receiving melanoma vaccines were excluded. Statistical comparisons used Chisquare analysis and the log-rank test. RESULTS: At a maximum follow up of 386 months (32 years) for the population of 1422 patients, rates of 15-, 20-, and 25-year melanoma-specific survival were 36% ± 1%, 35% ± 1%, and 35% ± 1%, respectively. When patients were stratified by clinical status of regional lymph nodes, survival rates were significantly lower (P = 0.001) if nodes were palpable. The number of tumor-positive nodes (P < 0.0001), the pathological primary tumor stage (P = 0.005), age (P = 0.0001), and gender (P = 0.002) also were significantly related to long-term survival. DISCUSSION: Long-term survivors of melanoma metastatic to regional lymph nodes are not uncommon, and the extremely low rate of recurrence beyond 15 years suggests that this disease-free interval is usually synonymous with cure. Although some risk factors decrease the likelihood of long-term survival, the high overall rates of extended survival in all risk groups clearly support surgical management as the primary treatment for regional metastatic melanoma.

KW - Lymph node

KW - Lymphadenectomy

KW - Melanoma

KW - Metastasis

KW - Stage III

KW - Surgery

KW - Survival

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