Melanoma: How Many Lymph Nodes Should Be Excised?

Dr. Carlo Riccardo Rossi, MD Melanoma and Sarcoma Unit, Veneto Institute of Oncology Surgery Branch, Department of Surgery Oncology, and Gastroenterology, University of Padova, Padova, ItalyMedicalResearch.com Interview with:
Dr. Carlo Riccardo Rossi, MD
Melanoma and Sarcoma Unit, Veneto Institute of Oncology
Surgery Branch, Department of Surgery
Oncology, and Gastroenterology, University of Padova,
Padova, Italy

MedicalResearch: What are the main findings of the study?

Dr. Rossi: A total of 90% patients undergone lymph node dissection for melanoma had 12, 7, 14, 6 and 13 excised lymph nodes (10th percentile of the distribution) after 3 level axillary, 3 level or less neck, 4 level or more neck, inguinal, or ilio-inguinal dissections, respectively.

MedicalResearch: Were any of the findings unexpected?

Dr. Rossi: These results reproduce those of Spillane et al. at the Melanoma Institute of Australia (ann surg oncol 2011; 18(9): 2521-2528).

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Rossi: Despite the clinical practice guidelines from the National Comprehensive Cancer Network report that there is insufficient evidence to identify a minimum number of lymph nodes that must be excised to consider a dissection adequate, these evidence based cut-offs can be taken into consideration by melanoma surgeons, while examining the pathological report  of a given lymph node dissection, to monitor the quality of their performance.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Rossi: Prospective evaluation of quality assurance programs (including the minimum number of lymph nodes to be excised by lymph node dissection) at melanoma surgical Units on clinical  practice and, likely, patients’ prognosis.

Citation:

Rossi C, Mozzillo N, Maurichi A, et al. Number of Excised Lymph Nodes as a Quality Assurance Measure for Lymphadenectomy in Melanoma. JAMA Surg. Published online May 07, 2014. doi:10.1001/jamasurg.2013.5676.