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 language | English (US) |
|---|---|
| Pages (from-to) | 207-211 |
| Number of pages | 5 |
| Journal | Cancer Journal |
| Volume | 12 |
| Issue number | 3 |
| DOIs | |
| State | Published - 2006 |
| Externally published | Yes |
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Keywords
- Lymph node
- Lymphadenectomy
- Melanoma
- Metastasis
- Stage III
- Surgery
- Survival
ASJC Scopus subject areas
- Cancer Research
- Oncology
Cite this
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 journal › Article
}
TY - JOUR
T1 - Can surgical therapy alone achieve long-term cure of melanoma metastatic to regional nodes?
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
Y1 - 2006
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
UR - http://www.scopus.com/inward/record.url?scp=33745175243&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33745175243&partnerID=8YFLogxK
U2 - 10.1097/00130404-200605000-00009
DO - 10.1097/00130404-200605000-00009
M3 - Article
C2 - 16803679
AN - SCOPUS:33745175243
VL - 12
SP - 207
EP - 211
JO - Cancer journal (Sudbury, Mass.)
JF - Cancer journal (Sudbury, Mass.)
SN - 1528-9117
IS - 3
ER -