Elective, Therapeutic, and Delayed Lymph Node Dissection for Malignant Melanoma of the Head and Neck: Analysis of 1444 Patients From 1970 to 1998
Objective The purpose of this article is to evaluate the effects on survival, disease‐free interval, and recurrence patterns for patients undergoing elective, therapeutic, and delayed lymph node dissection for malignant melanoma of the head and neck. Study Design and Methods A retrospective computer...
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| Veröffentlicht in: | The Laryngoscope 2002-01, Vol.112 (1), p.99-110 |
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| description | Objective The purpose of this article is to evaluate the effects on survival, disease‐free interval, and recurrence patterns for patients undergoing elective, therapeutic, and delayed lymph node dissection for malignant melanoma of the head and neck.
Study Design and Methods A retrospective computer‐aided analysis was performed comparing 1444 patients treated from 1970 to 1998 at Duke University Medical Center. A total of 446 of the 1444 (32%) of patients with head and neck melanoma underwent some form of lymph node dissection. Survival, disease‐free interval, and recurrence rates for patients having 1) no initial lymph node dissection (no LND), 2) elective lymph node dissection (ELND) within 2 months of date of diagnosis, 3) therapeutic lymph node dissection (TLND) for metastatic regional disease at diagnosis, or 4) delayed lymph node dissection (DLND) for patients developing regional lymph node metastasis later than 3 months from the date of diagnosis were compared.
Results A total of 246 patients undergoing ELND demonstrated 11% with occult disease. DLND for regional lymph node recurrence was reported at a median time interval of 1.2 years from diagnosis. Multivariate analysis indicated a significant improvement in survival for DLND when compared with patients undergoing ELND⊕ or TLND (P = .01). Distant metastasis was the site of first recurrence in 12% of patients undergoing no initial LND. Five‐year survival after DLND and TLND was 56% and 36%, respectively.
Conclusion Patients undergoing DLND had an overall better survival than patients undergoing TLND or ELND with positive nodes. The progression of metastatic disease following regional node disease occurred in 35% to 45% of cases, underscoring the need for effective adjunctive therapy. |
| doi_str_mv | 10.1097/00005537-200201000-00018 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_71415906</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>71415906</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4408-332993d7fad5e1053b73c6c412f7c2c45f7b026683be5983758583e9cc3605703</originalsourceid><addsrcrecordid>eNqNkdtuEzEQhi0EoqHwCsg3cNUFe22vbe6ipE0RaahQEHBlOd5ZYrqH1N7Q7mPwxjgH2lssWSN7vvk9nh8hTMk7SrR8T9ISgsksJyQnNJ2ytKl6gkZUMJpxrcVTNEpJlimRfz9BL2L8lQjJBHmOTihVqY4XI_TnvAbX-99whpdrCHYD2967M2zbEk-htgOUeD40mzVedCXgqY9xx3ctrrqAr2ztf7a27fFVYtuusbircL8GfAm23IsswN18wOPW1kP0cZemnHN8bXsPbR_xRegaTLUkuO9S1OolelbZOsKrYzxFXy_Ol5PLbP559nEynmeOc6IyxnKtWSkrWwqgRLCVZK5wnOaVdLnjopIrkheFYisQWjEplFAMtHOsIEISdoreHnQ3obvdQuxN46ODOv0Dum00knIqNCkSqA6gC12MASqzCb6xYTCUmJ0d5p8d5sEOs7cjlb4-vrFdNVA-Fh7nn4A3R8BGZ-sq2Nb5-Mgxnkuld0LTA3fnaxj-uwEzH3_5IQSnNN3u-8kOMj72cP8gY8ONKWQakfm2mJniupgtJ5-ImbO_Y3awOA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>71415906</pqid></control><display><type>article</type><title>Elective, Therapeutic, and Delayed Lymph Node Dissection for Malignant Melanoma of the Head and Neck: Analysis of 1444 Patients From 1970 to 1998</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Journals@Ovid Complete</source><creator>Fisher, Samuel R.</creator><creatorcontrib>Fisher, Samuel R.</creatorcontrib><description>Objective The purpose of this article is to evaluate the effects on survival, disease‐free interval, and recurrence patterns for patients undergoing elective, therapeutic, and delayed lymph node dissection for malignant melanoma of the head and neck.
Study Design and Methods A retrospective computer‐aided analysis was performed comparing 1444 patients treated from 1970 to 1998 at Duke University Medical Center. A total of 446 of the 1444 (32%) of patients with head and neck melanoma underwent some form of lymph node dissection. Survival, disease‐free interval, and recurrence rates for patients having 1) no initial lymph node dissection (no LND), 2) elective lymph node dissection (ELND) within 2 months of date of diagnosis, 3) therapeutic lymph node dissection (TLND) for metastatic regional disease at diagnosis, or 4) delayed lymph node dissection (DLND) for patients developing regional lymph node metastasis later than 3 months from the date of diagnosis were compared.
Results A total of 246 patients undergoing ELND demonstrated 11% with occult disease. DLND for regional lymph node recurrence was reported at a median time interval of 1.2 years from diagnosis. Multivariate analysis indicated a significant improvement in survival for DLND when compared with patients undergoing ELND⊕ or TLND (P = .01). Distant metastasis was the site of first recurrence in 12% of patients undergoing no initial LND. Five‐year survival after DLND and TLND was 56% and 36%, respectively.
Conclusion Patients undergoing DLND had an overall better survival than patients undergoing TLND or ELND with positive nodes. The progression of metastatic disease following regional node disease occurred in 35% to 45% of cases, underscoring the need for effective adjunctive therapy.</description><identifier>ISSN: 0023-852X</identifier><identifier>EISSN: 1531-4995</identifier><identifier>DOI: 10.1097/00005537-200201000-00018</identifier><identifier>PMID: 11802046</identifier><identifier>CODEN: LARYA8</identifier><language>eng</language><publisher>Hoboken, NJ: John Wiley & Sons, Inc</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Dermatology ; Disease-Free Survival ; Female ; Follow-Up Studies ; Head and neck melanoma ; Head and Neck Neoplasms - mortality ; Head and Neck Neoplasms - pathology ; Head and Neck Neoplasms - surgery ; Humans ; lymph node dissection ; Lymph Node Excision ; Lymph Nodes - pathology ; Lymphatic Metastasis ; Male ; Medical sciences ; Melanoma - mortality ; Melanoma - pathology ; Melanoma - surgery ; Middle Aged ; Neoplasm Recurrence, Local - mortality ; Neoplasm Recurrence, Local - pathology ; Neoplasm Recurrence, Local - surgery ; Neoplasm Staging ; Otorhinolaryngology (head neck, general aspects and miscellaneous) ; Otorhinolaryngology. Stomatology ; recurrence pattern ; Reoperation ; Skin Neoplasms - mortality ; Skin Neoplasms - pathology ; Skin Neoplasms - surgery ; Tumors ; Tumors of the skin and soft tissue. Premalignant lesions</subject><ispartof>The Laryngoscope, 2002-01, Vol.112 (1), p.99-110</ispartof><rights>Copyright © 2002 The Triological Society</rights><rights>2002 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4408-332993d7fad5e1053b73c6c412f7c2c45f7b026683be5983758583e9cc3605703</citedby><cites>FETCH-LOGICAL-c4408-332993d7fad5e1053b73c6c412f7c2c45f7b026683be5983758583e9cc3605703</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1097%2F00005537-200201000-00018$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1097%2F00005537-200201000-00018$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,4010,27900,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=13427898$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11802046$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fisher, Samuel R.</creatorcontrib><title>Elective, Therapeutic, and Delayed Lymph Node Dissection for Malignant Melanoma of the Head and Neck: Analysis of 1444 Patients From 1970 to 1998</title><title>The Laryngoscope</title><addtitle>The Laryngoscope</addtitle><description>Objective The purpose of this article is to evaluate the effects on survival, disease‐free interval, and recurrence patterns for patients undergoing elective, therapeutic, and delayed lymph node dissection for malignant melanoma of the head and neck.
Study Design and Methods A retrospective computer‐aided analysis was performed comparing 1444 patients treated from 1970 to 1998 at Duke University Medical Center. A total of 446 of the 1444 (32%) of patients with head and neck melanoma underwent some form of lymph node dissection. Survival, disease‐free interval, and recurrence rates for patients having 1) no initial lymph node dissection (no LND), 2) elective lymph node dissection (ELND) within 2 months of date of diagnosis, 3) therapeutic lymph node dissection (TLND) for metastatic regional disease at diagnosis, or 4) delayed lymph node dissection (DLND) for patients developing regional lymph node metastasis later than 3 months from the date of diagnosis were compared.
Results A total of 246 patients undergoing ELND demonstrated 11% with occult disease. DLND for regional lymph node recurrence was reported at a median time interval of 1.2 years from diagnosis. Multivariate analysis indicated a significant improvement in survival for DLND when compared with patients undergoing ELND⊕ or TLND (P = .01). Distant metastasis was the site of first recurrence in 12% of patients undergoing no initial LND. Five‐year survival after DLND and TLND was 56% and 36%, respectively.
Conclusion Patients undergoing DLND had an overall better survival than patients undergoing TLND or ELND with positive nodes. The progression of metastatic disease following regional node disease occurred in 35% to 45% of cases, underscoring the need for effective adjunctive therapy.</description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Dermatology</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Head and neck melanoma</subject><subject>Head and Neck Neoplasms - mortality</subject><subject>Head and Neck Neoplasms - pathology</subject><subject>Head and Neck Neoplasms - surgery</subject><subject>Humans</subject><subject>lymph node dissection</subject><subject>Lymph Node Excision</subject><subject>Lymph Nodes - pathology</subject><subject>Lymphatic Metastasis</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Melanoma - mortality</subject><subject>Melanoma - pathology</subject><subject>Melanoma - surgery</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local - mortality</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Neoplasm Recurrence, Local - surgery</subject><subject>Neoplasm Staging</subject><subject>Otorhinolaryngology (head neck, general aspects and miscellaneous)</subject><subject>Otorhinolaryngology. Stomatology</subject><subject>recurrence pattern</subject><subject>Reoperation</subject><subject>Skin Neoplasms - mortality</subject><subject>Skin Neoplasms - pathology</subject><subject>Skin Neoplasms - surgery</subject><subject>Tumors</subject><subject>Tumors of the skin and soft tissue. Premalignant lesions</subject><issn>0023-852X</issn><issn>1531-4995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2002</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkdtuEzEQhi0EoqHwCsg3cNUFe22vbe6ipE0RaahQEHBlOd5ZYrqH1N7Q7mPwxjgH2lssWSN7vvk9nh8hTMk7SrR8T9ISgsksJyQnNJ2ytKl6gkZUMJpxrcVTNEpJlimRfz9BL2L8lQjJBHmOTihVqY4XI_TnvAbX-99whpdrCHYD2967M2zbEk-htgOUeD40mzVedCXgqY9xx3ctrrqAr2ztf7a27fFVYtuusbircL8GfAm23IsswN18wOPW1kP0cZemnHN8bXsPbR_xRegaTLUkuO9S1OolelbZOsKrYzxFXy_Ol5PLbP559nEynmeOc6IyxnKtWSkrWwqgRLCVZK5wnOaVdLnjopIrkheFYisQWjEplFAMtHOsIEISdoreHnQ3obvdQuxN46ODOv0Dum00knIqNCkSqA6gC12MASqzCb6xYTCUmJ0d5p8d5sEOs7cjlb4-vrFdNVA-Fh7nn4A3R8BGZ-sq2Nb5-Mgxnkuld0LTA3fnaxj-uwEzH3_5IQSnNN3u-8kOMj72cP8gY8ONKWQakfm2mJniupgtJ5-ImbO_Y3awOA</recordid><startdate>200201</startdate><enddate>200201</enddate><creator>Fisher, Samuel R.</creator><general>John Wiley & Sons, Inc</general><general>Wiley-Blackwell</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>8BM</scope></search><sort><creationdate>200201</creationdate><title>Elective, Therapeutic, and Delayed Lymph Node Dissection for Malignant Melanoma of the Head and Neck: Analysis of 1444 Patients From 1970 to 1998</title><author>Fisher, Samuel R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4408-332993d7fad5e1053b73c6c412f7c2c45f7b026683be5983758583e9cc3605703</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2002</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Dermatology</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Head and neck melanoma</topic><topic>Head and Neck Neoplasms - mortality</topic><topic>Head and Neck Neoplasms - pathology</topic><topic>Head and Neck Neoplasms - surgery</topic><topic>Humans</topic><topic>lymph node dissection</topic><topic>Lymph Node Excision</topic><topic>Lymph Nodes - pathology</topic><topic>Lymphatic Metastasis</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Melanoma - mortality</topic><topic>Melanoma - pathology</topic><topic>Melanoma - surgery</topic><topic>Middle Aged</topic><topic>Neoplasm Recurrence, Local - mortality</topic><topic>Neoplasm Recurrence, Local - pathology</topic><topic>Neoplasm Recurrence, Local - surgery</topic><topic>Neoplasm Staging</topic><topic>Otorhinolaryngology (head neck, general aspects and miscellaneous)</topic><topic>Otorhinolaryngology. Stomatology</topic><topic>recurrence pattern</topic><topic>Reoperation</topic><topic>Skin Neoplasms - mortality</topic><topic>Skin Neoplasms - pathology</topic><topic>Skin Neoplasms - surgery</topic><topic>Tumors</topic><topic>Tumors of the skin and soft tissue. Premalignant lesions</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fisher, Samuel R.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>ComDisDome</collection><jtitle>The Laryngoscope</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fisher, Samuel R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Elective, Therapeutic, and Delayed Lymph Node Dissection for Malignant Melanoma of the Head and Neck: Analysis of 1444 Patients From 1970 to 1998</atitle><jtitle>The Laryngoscope</jtitle><addtitle>The Laryngoscope</addtitle><date>2002-01</date><risdate>2002</risdate><volume>112</volume><issue>1</issue><spage>99</spage><epage>110</epage><pages>99-110</pages><issn>0023-852X</issn><eissn>1531-4995</eissn><coden>LARYA8</coden><abstract>Objective The purpose of this article is to evaluate the effects on survival, disease‐free interval, and recurrence patterns for patients undergoing elective, therapeutic, and delayed lymph node dissection for malignant melanoma of the head and neck.
Study Design and Methods A retrospective computer‐aided analysis was performed comparing 1444 patients treated from 1970 to 1998 at Duke University Medical Center. A total of 446 of the 1444 (32%) of patients with head and neck melanoma underwent some form of lymph node dissection. Survival, disease‐free interval, and recurrence rates for patients having 1) no initial lymph node dissection (no LND), 2) elective lymph node dissection (ELND) within 2 months of date of diagnosis, 3) therapeutic lymph node dissection (TLND) for metastatic regional disease at diagnosis, or 4) delayed lymph node dissection (DLND) for patients developing regional lymph node metastasis later than 3 months from the date of diagnosis were compared.
Results A total of 246 patients undergoing ELND demonstrated 11% with occult disease. DLND for regional lymph node recurrence was reported at a median time interval of 1.2 years from diagnosis. Multivariate analysis indicated a significant improvement in survival for DLND when compared with patients undergoing ELND⊕ or TLND (P = .01). Distant metastasis was the site of first recurrence in 12% of patients undergoing no initial LND. Five‐year survival after DLND and TLND was 56% and 36%, respectively.
Conclusion Patients undergoing DLND had an overall better survival than patients undergoing TLND or ELND with positive nodes. The progression of metastatic disease following regional node disease occurred in 35% to 45% of cases, underscoring the need for effective adjunctive therapy.</abstract><cop>Hoboken, NJ</cop><pub>John Wiley & Sons, Inc</pub><pmid>11802046</pmid><doi>10.1097/00005537-200201000-00018</doi><tpages>12</tpages></addata></record> |
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| subjects | Adult Aged Biological and medical sciences Dermatology Disease-Free Survival Female Follow-Up Studies Head and neck melanoma Head and Neck Neoplasms - mortality Head and Neck Neoplasms - pathology Head and Neck Neoplasms - surgery Humans lymph node dissection Lymph Node Excision Lymph Nodes - pathology Lymphatic Metastasis Male Medical sciences Melanoma - mortality Melanoma - pathology Melanoma - surgery Middle Aged Neoplasm Recurrence, Local - mortality Neoplasm Recurrence, Local - pathology Neoplasm Recurrence, Local - surgery Neoplasm Staging Otorhinolaryngology (head neck, general aspects and miscellaneous) Otorhinolaryngology. Stomatology recurrence pattern Reoperation Skin Neoplasms - mortality Skin Neoplasms - pathology Skin Neoplasms - surgery Tumors Tumors of the skin and soft tissue. Premalignant lesions |
| title | Elective, Therapeutic, and Delayed Lymph Node Dissection for Malignant Melanoma of the Head and Neck: Analysis of 1444 Patients From 1970 to 1998 |
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