Selective use of wide excision with elective lymph node dissection for malignant melanoma.

ABSTRACT

One hundred and eighty individuals with clinically negative regional lymph nodes are the basis of this study. One hundred and ten of these underwent an elective lymph node dissection. The incidence of histologically positive lymph nodes was 0 percent, 17 percent, and 42 percent for those with thin, intermediate thickness and deeply invasive lesions. Of these 25 patients with histologically positive lymph nodes, the metastases were micro in size (less than or equal to 2 mm) in 75 percent of the intermediate thickness group compared with 38 percent of the deeply invasive group. At the present time, the size of lymph node metastases appears to correlate with disease-free estimates at 2 years, the disease-free estimates are 70 percent for those with micro metastases and 24 percent for those with macro metastases. Therapeutic success is influenced greatly by the number of circulating cancer cells challenging the host's defense mechanism. The large cell mass of clinically evident metastatic disease would appear to present most patients with an uncontrollable number.