OPTIMIZING THE STAGING OF MELANOMA PATIENTS FOR THEIR BEST SURGICAL MANAGEMENT

Abstract

Interval nodes (IN) are defined as lymph

nodes that lie along the course of lymphatic

collecting vessels between a primary tumor

site and a draining node field. Sometimes INs

contain metastases and a consensus on their

surgical management is needed. Therefore,

to optimize the surgical management of

melanoma patients with metastatic lymphatic

involvement, especially when the sentinel

lymph node biopsy identifies an unusual

drainage field, we identified patients treated at

the Department of Plastic and Reconstruction

Surgery of Bari between July 1994 and

December 2012 identified with a primarycutaneous

melanoma who underwent

lymphoscintigraphy and subsequent positive-

IN the lymphadenectomy to evaluate the

impact of this procedure on overall survival

and disease-free-period. 51 patients presented

INs, and lymphadenectomy (LA) of the

subsequent lymphatic field was performed in

13 subjects with positive-IN. In 4 cases

additional lymphatic metastases were detected

in the usual basin beyond the IN+.

Recurrence-free period and survival rate at

5 years were higher in patients with positive-

IN who underwent LA than in subjects who

underwent LA due to positive lymph nodes

in the usual field. Immediate lymphadenectomy

of the subsequent lymphatic field in

patients with positive-INs may afford patients

earlier stage treatment of their disease and

improved prognosis.