Although significant progress has been made in the understanding of melanoma pathophysiology and therapy, patients with metastatic melanoma still have a poor prognosis.,The management of regional nodes remains a matter of debate.,By replacing elective lymph node dissection, sentinel lymph node biopsy has revolutionized the treatment of malignant melanoma.,In this paper, the history of the procedure is traced, and the indication for completion lymphadenectomy after positive sentinel node biopsy is discussed in light of the recent studies that addressed this issue.,The role of adjuvant therapies in the management of patients with stage III melanoma is also discussed.
Management of patients with clinically detectable lymph node metastasis to the groin is by ilioinguinal or combined superficial and deep groin dissection (CGD) according to most literature, but in practice superficial groin dissection (SGD) only is still performed in some centers.,The aim of this study is to evaluate the experience in CGD versus SGD patients in our center.,Between 1991 and 2009, 121 therapeutic CGD and 48 SGD were performed in 169 melanoma patients with palpable groin metastases at our institute.,Median follow-up was 20 and, for survivors, 45 months.,In this heterogeneous group of patients, overall (OS) and disease-free survival, local control rates, and morbidity rates were not significantly different between CGD and SGD patients.,However, CGD patients had a trend towards more chronic lymphedema.,Superficial lymph node ratio, the number of positive superficial lymph nodes, and the presence of deep nodes were prognostic factors for survival.,CGD patients with involved deep lymph nodes (24.8%) had estimated 5-year OS of 12% compared with 40% with no involved deep lymph nodes (p = 0.001).,Preoperative computed tomography (CT) scan had high negative predictive value of 91% for detection of pelvic nodal involvement.,This study demonstrated that survival and local control do not differ for patients with palpable groin metastases treated by CGD or SGD.,Patients without pathological iliac nodes on CT might safely undergo SGD, while CGD might be reserved for patients with multiple positive nodes on SGD and/or positive deep nodes on CT scan.