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Open Access 01-12-2015 | Melanomas

Risk Factors for Positive Deep Pelvic Nodal Involvement in Patients with Palpable Groin Melanoma Metastases: Can the Extent of Surgery be Safely Minimized?

A Retrospective, Multicenter Cohort Study

Authors: C. M. C. Oude Ophuis, MD, A. C. J. van Akkooi, MD, PhD, H. J. Hoekstra, MD, PhD, J. J. Bonenkamp, MD, PhD, J. van Wissen, MD, M. G. Niebling, MD, PhD, J. H. W. de Wilt, MD, PhD, B. van der Hiel, MD, B. van de Wiel, MD, S. Koljenović, MD, PhD, D. J. Grünhagen, MD, PhD, C. Verhoef, MD, PhD

Published in: Annals of Surgical Oncology | Special Issue 3/2015

Abstract

Background

Patients with palpable melanoma groin metastases have a poor prognosis. There is debate whether a combined superficial and deep groin dissection (CGD) is necessary or if superficial groin dissection (SGD) alone is sufficient.

Aim

The aim of this study was to analyze risk factors for deep pelvic nodal involvement in a retrospective, multicenter cohort of palpable groin melanoma metastases. This could aid in the development of an algorithm for selective surgery in the future.

Methods

This study related to 209 therapeutic CGDs from four tertiary centers in The Netherlands (1992–2013), selected based on complete preoperative imaging and pathology reports. Analyzed risk factors included baseline and primary tumor characteristics, total and positive number of inguinal nodes, inguinal lymph node ratio (LNR) and positive deep pelvic nodes on imaging (computed tomography [CT] ± positron emission tomography [PET], or PET − low-dose CT).

Results

Median age was 57 years, 54 % of patients were female, and median follow-up was 21 months (interquartile range [IQR] 11–46 months). Median Breslow thickness was 2.10 mm (IQR 1.40–3.40 mm), and 26 % of all primary melanomas were ulcerated. Positive deep pelvic nodes occurred in 35 % of CGDs. Significantly fewer inguinal nodes were positive in case of negative deep pelvic nodes (median 1 [IQR 1–2] vs. 3 [IQR 1–4] for positive deep pelvic nodes; p < 0.001), and LNR was significantly lower for negative versus positive deep pelvic nodes [median 0.15 (IQR 0.10–0.25) vs. 0.33 (IQR 0.14–0.54); p < 0.001]. A combination of negative imaging, low LNR, low number of positive inguinal nodes, and no extracapsular extension (ECE) could accurately predict the absence of pelvic nodal involvement in 84 % of patients.

Conclusions

Patients with negative imaging, few positive inguinal nodes, no ECE, and low LNR have a low risk of positive deep pelvic nodes and may safely undergo SGD alone.

Balch CM, Gershenwald JE, Soong SJ, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27(36):6199–6206.PubMedPubMedCentralCrossRef

Badgwell B, Xing Y, Gershenwald JE, et al. Pelvic lymph node dissection is beneficial in subsets of patients with node-positive melanoma. Ann Surg Oncol. 2007;14(10):2867–75.PubMedCrossRef

Allan CP, Hayes AJ, Thomas JM. Ilioinguinal lymph node dissection for palpable metastatic melanoma to the groin. ANZ J Surg. 2008;78(11):982–6.PubMedCrossRef

Mack LA, McKinnon JG. Controversies in the management of metastatic melanoma to regional lymphatic basins. J Surg Oncol. 2004;86(4):189–199.PubMedCrossRef

Nowecki ZI, Rutkowski P, Michej W. The survival benefit to patients with positive sentinel node melanoma after completion lymph node dissection may be limited to the subgroup with a primary lesion Breslow thickness greater than 1.0 and less than or equal to 4 mm (pT2-pT3). Ann Surg Oncol. 2008;15(8):2223–34.PubMedCrossRef

van der Ploeg AP, van Akkooi AC, Schmitz PI, et al. Therapeutic surgical management of palpable melanoma groin metastases: superficial or combined superficial and deep groin lymph node dissection. Ann Surg Oncol. 2011;18(12):3300–8.PubMedPubMedCentralCrossRef

Niebling MG, Wevers KP, Suurmeijer AJ, van Ginkel RJ, Hoekstra HJ. Deep lymph node metastases in the groin significantly affects prognosis, particularly in sentinel node-positive melanoma patients. Ann Surg Oncol. 2015;22(1):279–286.PubMedCrossRef

Coit DG, Brennan MF. Extent of lymph node dissection in melanoma of the trunk or lower extremity. Arch Surg. 1989;124(2):162–6.PubMedCrossRef

Karakousis CP, Emrich LJ, Rao U. Groin dissection in malignant melanoma. Am J Surg. 1986;152(5):491–5.PubMedCrossRef

10.

Strobbe LJ, Jonk A, Hart AA, Nieweg OE, Kroon BB. Positive iliac and obturator nodes in melanoma: survival and prognostic factors. Ann Surg Oncol. 1999;6(3):255–262.PubMedCrossRef

11.

Kretschmer L, Neumann C, Preusser KP, Marsch WC. Superficial inguinal and radical ilioinguinal lymph node dissection in patients with palpable melanoma metastases to the groin: an analysis of survival and local recurrence. Acta Oncol. 2001;40(1):72–78.PubMedCrossRef

12.

Egger ME, Brown RE, Roach BA, et al. Addition of an iliac/obturator lymph node dissection does not improve nodal recurrence or survival in melanoma. J Am Coll Surg. 2014;219(1):101–8.PubMedCrossRef

13.

Karakousis CP, Driscoll DL. Groin dissection in malignant melanoma. Br J Surg. 1994;81(12):1771–4.PubMedCrossRef

14.

Sterne GD, Murray DS, Grimley RP. Ilioinguinal block dissection for malignant melanoma. Br J Surg. 1995;82(8):1057–9.PubMedCrossRef

15.

Mann GB, Coit DG. Does the extent of operation influence the prognosis in patients with melanoma metastatic to inguinal nodes? Ann Surg Oncol. 1999;6(3):263–271.PubMedCrossRef

16.

Bastiaannet E, Wobbes T, Hoekstra OS, et al. Prospective comparison of [18F]fluorodeoxyglucose positron emission tomography and computed tomography in patients with melanoma with palpable lymph node metastases: diagnostic accuracy and impact on treatment. J Clin Oncol. 2009;27(28):4774–80.PubMedCrossRef

17.

Pasquali S, Mocellin S, Bigolin F, et al. Pelvic lymph node status prediction in melanoma patients with inguinal lymph node metastasis. Melanoma Res. 2014;24(5):462–7.PubMedCrossRef

18.

Glover AR, Allan CP, Wilkinson MJ, Strauss DC, Thomas JM, Hayes AJ. Outcomes of routine ilioinguinal lymph node dissection for palpable inguinal melanoma nodal metastasis. Br J Surg. 2014;101(7):811–9.PubMedCrossRef

19.

Hughes TM, Thomas JM. Combined inguinal and pelvic lymph node dissection for stage III melanoma. Br J Surg. 1999;86(12):1493–8.PubMedCrossRef

20.

Hughes TM, A’Hern RP, Thomas JM. Prognosis and surgical management of patients with palpable inguinal lymph node metastases from melanoma. Br J Surg. 2000;87(7):892–901.PubMedCrossRef

21.

Zdzienicki M, Rutkowski P, Nowecki ZI, et al. The analysis of the outcomes and factors related to iliac-obturator involvement in cutaneous melanoma patients after lymph node dissection due to positive sentinel lymph node biopsy or clinically detected inguinal metastases. Eur J Surg Oncol. 2013;39(3):304–310.PubMedCrossRef

22.

Poos HP, Kruijff S, Bastiaannet E, van Ginkel RJ, Hoekstra HJ. Therapeutic groin dissection for melanoma: risk factors for short term morbidity. Eur J Surg Oncol. 2009;35(8):877–883.PubMedCrossRef

23.

Rbah-Vidal L, Vidal A, Besse S, et al. Early detection and longitudinal monitoring of experimental primary and disseminated melanoma using [(1)(0)F]ICF01006, a highly promising melanoma PET tracer. Eur J Nucl Med Mol Imaging. 2012;39(9):1449–61.PubMedCrossRef

24.

24. Khosrotehrani K, van der Ploeg AP, Siskind V, et al. Nomograms to predict recurrence and survival in stage IIIB and IIIC melanoma after therapeutic lymphadenectomy. Eur J Cancer. 2014;50(7):1301–9.PubMedCrossRef

25.

Kruijff S, Bastiaannet E, Speijers MJ, Kobold AC, Brouwers AH, Hoekstra HJ. The value of pre operative S-100B and SUV in clinically stage III melanoma patients undergoing therapeutic lymph node dissection. Eur J Surg Oncol. 2011;37(3):225–232.PubMedCrossRef

26.

Kruijff S, Hoekstra HJ. The current status of S-100B as a biomarker in melanoma. Eur J Surg Oncol. 2012;38(4):281–5.PubMedCrossRef

27.

Glarner CE, Greenblatt DY, Rettammel RJ, Neuman HB, Weber SM. Wound complications after inguinal lymph node dissection for melanoma: is ACS NSQIP adequate? Ann Surg Oncol. 2013;20(6):2049–55.PubMedPubMedCentralCrossRef

Title: Risk Factors for Positive Deep Pelvic Nodal Involvement in Patients with Palpable Groin Melanoma Metastases: Can the Extent of Surgery be Safely Minimized?
A Retrospective, Multicenter Cohort Study
Authors: C. M. C. Oude Ophuis, MD
A. C. J. van Akkooi, MD, PhD
H. J. Hoekstra, MD, PhD
J. J. Bonenkamp, MD, PhD
J. van Wissen, MD
M. G. Niebling, MD, PhD
J. H. W. de Wilt, MD, PhD
B. van der Hiel, MD
B. van de Wiel, MD
S. Koljenović, MD, PhD
D. J. Grünhagen, MD, PhD
C. Verhoef, MD, PhD
Publication date: 01-12-2015
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue Special Issue 3/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-015-4602-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk Factors for Positive Deep Pelvic Nodal Involvement in Patients with Palpable Groin Melanoma Metastases: Can the Extent of Surgery be Safely Minimized?

A Retrospective, Multicenter Cohort Study

Abstract

Background

Aim

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Aim

Methods

Results

Conclusions

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