Inguinal and Ilio-inguinal Lymphadenectomy in Management of Palpable Melanoma Lymph Node Metastasis: A Long-Term Prospective Evaluation of Morbidity and Quality of Life.

PURPOSE: Prospective data are lacking on long-term morbidity of inguinal lymphadenectomy including the influence of extent of surgery, use of radiotherapy, and patient factors. The aim of this study is to evaluate the effects of these factors on patient outcome, quality of life (QOL), regional symptoms, and limb volumes after inguinal or ilio-inguinal lymphadenectomy for melanoma. METHODS: Analysis of the subgroup of patients with inguinal lymph node field relapse of melanoma, treated by inguinal or ilio-inguinal lymphadenectomy in the ANZMTG/TROG randomized trial of adjuvant radiotherapy versus observation. RESULTS: Sixty-nine patients, 46 having undergone inguinal and 23 ilio-inguinal lymphadenectomy, with median follow-up of 73 months were analyzed. Mean limb volume increased rapidly after surgery (7% by 3 months) and continued to increase for at least another 18 months. Patients with body mass index (BMI) ≥ 25 kg/m2 had greater limb volume increase than normal-weight patients (13.3% versus 6.9%, P = 0.030). QOL improved over the first 18 months, but despite initial improvement, regional symptoms persisted long term. Type of surgery (inguinal or ilio-inguinal lymphadenectomy) had no demonstrably significant effect on limb volume (9.9% versus 13.4%, P = 0.35), QOL (P = 0.68), or regional symptoms (P = 0.65). There was no difference in overall survival between inguinal and ilio-inguinal lymphadenectomy [hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.40-1.40, P = 0.43]. CONCLUSIONS: Inguinal lymphadenectomy for melanoma is a potentially morbid procedure with significant increases in limb volume. Patients report reasonable QOL but may have ongoing regional symptoms. Overweight/obesity is associated with poorer QOL, increased limb volume, and regional symptoms.

Oncology service correspondence: do we communicate?

The aim of this study is to assess the content of letters sent from a hospital oncology service regarding the initial assessment of new referrals and the requirements of hospital specialists and General Practitioners (GPs) regarding oncology service correspondence. The content of letters regarding the initial consultation of 204 consecutive new oncology patients was analysed. General Practitioners and referring specialists were sent a 13-point survey to gauge their preferences for the information contained in oncology correspondence pertaining to the initial assessment of an oncology patient. Seventy-two percent of the patients had a letter written following their initial oncology assessment. The GP received a copy of 81% of the letters (58% of the study sample). The diagnosis was recorded in all our letters, and the proposed treatment plan was addressed in 84% of our letters. Both GPs and specialists required information on examination and investigation findings, diagnosis, treatment options, proposed management plan, and what the patient was told. The GPs required further information on current medication, likely side-effects of the proposed management, and clarification of when to contact the oncologist. The majority of the respondents were in favour of a structured letter.