Standardized axillary lymphadenectomy improves local control but not survival in patients with palpable lymph node metastases of cutaneous malignant melanoma

Background: The aim of the present study was to investigate whether consistent application of standard surgical techniques contributes to improved local control or improved survival in melanoma patients with palpable lymph node metastases to the axilla. Method: Using Kaplan-Meier estimations and the Cox proportional hazards model, 120 axillary dissections were assessed. The data from 63 patients who had received standardized axillary lymphadenectomy were compared to those of 57 patients operated on before the introduction of standardized lymphadenectomy. Results: The introduction of standardized axillary lymphadenectomy led to a significant decrease in 5-year local recurrence probability from 43.1% to 13.1% (P=0.0008). Using multifactorial analysis, the standardized operative procedure resulted in a significantly lower risk of recurrence in the dissected axilla (P=0.009). The development of in-transit metastases was also related to recurrence in the nodal basin (P=0.03). No significance was accorded to the number of metastatic lymph nodes, tumor thickness, epidermal ulceration, site of primary melanoma, age, sex, or adjuvant chemotherapy. Notably, no differences in the survival rates were observed between the two treatment groups. Conclusion: In patients with palpably enlarged axillary lymph node metastases, the introduction of a complete lymphadenectomy, standardized according to the currently acknowledged principles of oncological surgery, improves local disease control without improving overall survival.