ABSTRACT
Local treatment of primary melanoma is by excision with a margin of surrounding normal skin. Whether and when the regional lymph nodes should be excised in patients with metastasis-prone, thick primary melanomas is more debatable.1 One school considers that the ipsilateral regional nodes should be dissected at the time of removal of the primary melanoma. This approach, known as elective or prophylactic lymph-node dissection,2,3 is supported by observations that patients whose melanomas are confined to the site of origin are less likely to die of their disease than patients with tumor spread to the regional nodes. Additionally, 20-30% (the proportion varying with primary melanoma thickness) of patients with nodes that are negative on clinical assessment have nodal tumor when examined by histologic and immunohistologic methods.4 If all individuals with high-risk melanoma are treated by elective lymph-node dissection, however, 70-80% will be subjected to an unnecessary and significantly morbid surgical operation. Alternatively, lymph-node dissection may be reserved for patients with clinically detectable nodal tumor (therapeutic lymph-node dissection).5,6 This spares many patients an unnecessary operation,
but delays definitive therapy beyond the optimum point of deployment and thus deprives these individuals of their best chance of cure.
