Elective lymph-node dissection for melanoma

Abstract

The value of elective lymph-node dissection in the treatment of malignant melanoma is controversial. It can be beneficial only if the apparently normal lymph-nodes contain metastases. Unfortunately, there is no way of telling before operation whether they do or not. However, a knowledge of the factors which suggest, on statistical grounds, a good or bad prognosis can help to forecast whether the lymphnodes are likely to contain metastases. If there are factors suggesting a good prognosis the regional nodes are not likely to contain occult metastases. In these circumstances elective dissection should be avoided and reliance placed on regular clinical evaluation of the nodes with subsequent therapeutic dissection if indicated. If there are factors suggesting a bad prognosis the regional nodes may contain occult metastases and prophylactic dissection should be seriously considered. However, if follow-up facilities are good the alternative method of obseration is acceptable and the choice of treatment will rest with the surgeon and the patient. The site of the tumour is also important. If a deeply invasive melanoma overlies or is immediately adjacent to the regional nodes, elective dissection is indicated. On the other hand, if the melanoma is in an area with unpredictable lymph drainage or if it is at a distance from the nodes, observation is the best policy.