The number of lymph nodes involved with metastatic disease does not affect outcome in melanoma patients as long as all disease is confined to the sentinel lymph node.

BACKGROUND: In melanoma, a direct relationship exists between the number of nodes involved with metastatic disease and prognosis. This study was undertaken to determine whether an individual with metastatic disease confined to the sentinel lymph nodes (SLNs) would have a better prognosis than individuals with metastatic disease that has spread to the non-SLNs, regardless of the number of nodes involved. METHODS: The study group consists of 229 melanoma patients with a positive SLN who underwent regional nodal dissection. Cox proportional hazard regression models were used to assess association of the number of SLNs and non-SLNs involved with disease with overall survival (OS) and disease-free survival (DFS). RESULTS: DFS and OS were unchanged regardless of how many SLNs were positive, as long as all disease was confined to SLNs. Among 183 patients without involvement of non-SLNs, OS remained the same despite an increasing number of SLNs involved (P = .59). This was true after controlling for ulceration, Breslow depth, age, sex, and adjuvant treatment. Once disease was present beyond the SLN, DFS and OS were negatively affected. Among patients with involvement of non-SLNs, there was no statistically significant association between the number of positive SLNs and survival. The risk of mortality increased with the number of non-SLNs involved with metastatic disease (P < .001). CONCLUSIONS: The number of regional nodes involved with metastatic disease does not affect DFS and OS if disease is confined to the SLNs. Consideration should be given to specifying SLN versus non-SLN involvement in the American Joint Committee on Cancer staging manual.

Regional Therapy for Recurrent Metastatic Melanoma Confined to the Extremity: Hyperthermic Isolated Limb Perfusion vs. Isolated Limb Infusion.

Melanoma patients with recurrent disease confined to an extremity can be offered one of two regional therapies that both give high complete response rates. Isolated limb infusion (ILI) is a newer technique performed with catheters and tourniquets that has a reduced potential morbidity, decreased efficacy and does not treat the regional nodal basin. Hyperthermic Isolated Limb Perfusion (HILP) is an open surgical technique that includes removal of the regional nodal basin as part of the surgical procedure. An analysis was performed of the rates of regional nodal disease in this patient population to determine the percentage of patients with stage III metastatic disease to the lymph nodes that would be under treated with the ILI technique. A total of 229 patients underwent a HILP for melanoma with regional lymph node dissection as is our standard between July 1987 and December 2009. Ninty-two of the 229 patients (40%) had metastatic regional nodal disease documented at the time of the HILP procedure. HILP is the only technique that addresses all micrometastatic disease on the extremity.