Axillary lymph node dissection for malignant melanoma

Background: Malignant melanoma is a common and life-threatening malignancy that often metastasizes to lymph nodes, necessitating lymph node dissections. Dissections aim for regional disease control. Dissections often result in significant morbidity and are associated with local recurrences (LRs) in the surgical field. This study aims to ascertain the LR rate and complication rate in axillary lymph node dissections (ALND) for malignant melanoma. It also aims to identify risk factors for both LR and complications. Methods: This retrospective clinical study involved the analysis of 74 patients who were identified by the Victorian Melanoma Service database as having ALND between 1999 and 2008. Three patients underwent bilateral ALND and three patients underwent reoperative procedures following initial incomplete dissections. Patient demographics and information on the primary tumour was collected using a prospectively kept database and histopathological reports. Operative and post-operative information was obtained through a retrospective review of clinical notes and histopathological reports. Results: Twelve (16%) patients developed LR at a median follow-up time of 9.5 months, and 32 (46%) patients had a post-operative complication. Kaplan-Meier estimates revealed an overall risk of LR to be 24.96% (95% CI: 13.8%-45.1%). Cox regression analysis revealed that having a primary melanoma upon the abdomen statistically significantly increased the risk of LR in the dissected field. (Hazard ratio 3.84; 95% CI: 1.0-15.0; P = 0.048). Twenty-eight (38%) patients died from disseminated disease. Conclusions: ALND is associated with a significant risk of post-operative complications. It can achieve regional disease control, but a significant risk of LR exists. If LR occurs the prognosis is very poor.