Elective, therapeutic, and delayed lymph node dissection for malignant melanoma of the head and neck: analysis of 1444 patients from 1970 to 1998.


Journal Article

OBJECTIVE: The purpose of this article is to evaluate the effects on survival, disease-free interval, and recurrence patterns for patients undergoing elective, therapeutic, and delayed lymph node dissection for malignant melanoma of the head and neck. STUDY DESIGN AND METHODS: A retrospective computer-aided analysis was performed comparing 1444 patients treated from 1970 to 1998 at Duke University Medical Center. A total of 446 of the 1444 (32%) of patients with head and neck melanoma underwent some form of lymph node dissection. Survival, disease-free interval, and recurrence rates for patients having 1) no initial lymph node dissection (no LND), 2) elective lymph node dissection (ELND) within 2 months of date of diagnosis, 3) therapeutic lymph node dissection (TLND) for metastatic regional disease at diagnosis, or 4) delayed lymph node dissection (DLND) for patients developing regional lymph node metastasis later than 3 months from the date of diagnosis were compared. RESULTS: A total of 246 patients undergoing ELND demonstrated 11% with occult disease. DLND for regional lymph node recurrence was reported at a median time interval of 1.2 years from diagnosis. Multivariate analysis indicated a significant improvement in survival for DLND when compared with patients undergoing ELND plus sign in circle or TLND (P =.01). Distant metastasis was the site of first recurrence in 12% of patients undergoing no initial LND. Five-year survival after DLND and TLND was 56% and 36%, respectively. CONCLUSION: Patients undergoing DLND had an overall better survival than patients undergoing TLND or ELND with positive nodes. The progression of metastatic disease following regional node disease occurred in 35% to 45% of cases, underscoring the need for effective adjunctive therapy.

Full Text

Cited Authors

  • Fisher, SR

Published Date

  • January 2002

Published In

Volume / Issue

  • 112 / 1

Start / End Page

  • 99 - 110

PubMed ID

  • 11802046

Pubmed Central ID

  • 11802046

Electronic International Standard Serial Number (EISSN)

  • 1531-4995

International Standard Serial Number (ISSN)

  • 0023-852X

Digital Object Identifier (DOI)

  • 10.1097/00005537-200201000-00018


  • eng