Completion lymphadenectomy may not increase in-transit disease in malignant melanoma

doi:10.1136/bmj.329.7477.1288-c

BMJ 2004;329:1288-1289 (27 November), doi:10.1136/bmj.329.7477.1288-c

Letter

Completion lymphadenectomy may not increase in-transit disease in malignant melanoma

The first 150 words of the full text of this article appear below.

EDITOR—The arguments put forward by Thomas and Clark againstthe use of sentinel node biopsy in malignant melanoma have notchanged over the past four years.^1
2 However, data are now availableto test the hypothesis that completion lymphadenectomy mightincrease the rate of in-transit disease.

We identified 10 studies, including our own, which report patternsof relapse separately according to sentinel node status.³ Overallwe found 701 relapses among 4713 subjects, of which 94 werenodal, 201 were either in-transit or local recurrence, and 406were distant, giving an absolute rate of 2%, 4.3%, and 8.8%,respectively. In cohorts not subjected to selective lymphadenectomythe equivalent figures are 7.8% nodal, 3.4% in-transit, and4.4% distant.⁴ In other words, selective lymphadenectomy reducesthe absolute rate of nodal relapse mainly at the expense ofan increased rate of distant metastases. It is difficult toattach too much importance to the . . . [Full text of this article]

Robin Russell-Jones, director, skin tumour unit

russelljones@btinternet.com

Ciaran Healy, consultant plastic surgeon, department of plastic surgery, Ann-Marie Powell, specialist registrar, skin tumour unit, Katharine Acland, consultant dermatologist, skin tumour unit, Michael O'Doherty, consultant nuclear physician, department of nuclear medicine, Eduardo Calonje, director, diagnostic dermatopathology

St John's Institute of Dermatology, St Thomas Hospital, London SE1 7EH

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