MELANOMA OF TRUNK - RESULTS OF SURGICAL EXCISION AND ANATOMIC GUIDELINES FOR PREDICTING NODAL METASTASIS

  • 1 January 1976
    • journal article
    • research article
    • Vol. 80  (1) , 22-30
Abstract
From 1958-1969, inclusive, 418 patients with melanoma of the trunk were treated at the M.D. Anderson Hospital and Tumor Institute. Of these, 128 patients (31%) had stage I disease and were treated by excision with observation of regional nodes in all except 5 patients. Retrospectively these stage I patients were analyzed regarding survival, sites and timing of treatment failures, the relation of the primary site to eventual nodal metastasis and the variables of sex, size and location on the trunk, which also were correlated with disease control. The results show an actuarial survival rate of 65.7% and 55.7% at 5 and 10 yr, respectively. Positive regional lymph nodes (RLN) evolved in 34 patients (28%), systemic metastases in 18 patients (15%), local recurrence (LR) in 4 patients, LR plus RLN in 1 patient and intransit metastases in 3 patients as the 1st evidence of failure. Over 90% of LR and positive RLN developed within 24 mo. Many intransit recurrences and systemic metastases occurred later and account for much of the biologic variability attributed to melanomas. The anatomy of the lymphatics of the trunk as described by Sappey is an excellent guide to the site of 1st nodal metastasis. A midline or near-midline primary site correlated with regional failure (P < 0.05). More men failed regionally than women (P < 0.05). In retrospective calculation, 184 regional node dissections would have been required for probable salvage of 13 patients (10%) if surgical treatment for subclinical disease was used routinely.

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