Inguinal lymph nodes4/19/2023 ![]() The clinical and pathologic characteristics are presented in Table Table1. Three patients had lymphadenectomy (3.4%) only, and 4 patients had concomitant resection of melanoma and lymphadenectomy (4.6%). Seventy-nine patients had a complete resection of the initial melanoma (92%). Initial treatment was not known for 2 patients. Ulceration of the primary tumour was found in 12 patients. The Clark level was known in 66 patients and was: level I in 1 patient, level II in 1 patient, level III in 16 patients, level IV in 44 patients and level V in 4 patients. The median Breslow index was 2.5 mm (0.15 to 33 mm). The median age at which the melanoma was diagnosed was 51 years (18 to 87 years). The statistical package SPSS 13.0 (SPSS Inc., Chicago, IL, USA) was used to perform the analysis.Įighty-six patients were treated for metastatic lymph nodes from melanoma between August 1996 and November 2009. All statistical tests were two-sided, and a p value of <0.05 was considered statistically significant. Univariate analysis was performed according to Cox's proportional hazard. Univariate analysis of the patients' survival was carried out using the Kaplan-Meier method with 95% confidence intervals (CI) and a log-rank comparison to evaluate the difference between the survival curves. We carried out 3 successive analyses: (i) an identification of prognostic factors on the whole cohort (ii) a crude survival analysis according to the treatment performed (iii) a stratified survival analysis according to prognostic factor(s) identified. The secondary endpoint was overall survival. The primary endpoint was regional control, which was defined as complete and permanent eradication of tumour in treated area. The distribution of categorical variables was tested using a Fisher exact test and chi-square test for trends. We tried to assess whether adjuvant radiation therapy was advantageous in locally advanced melanoma, which minimal dose and radiation regimen should be used, and for which patients it should be used. In this study, we reviewed our experience in the treatment of locally advanced melanoma in order to identify prognostic factors. In our centre, we chose to use a standard fractionation regimen for the management of these patients. Most of these retrospective studies used a hypofractionated radiation regimen (30 Gy in 5 fractions). This treatment had no impact on disease-free survival or overall survival. They showed the benefit of radiation therapy in preventing local recurrence in metastatic lymph nodes from cutaneous melanoma after lymphadenectomy. Several retrospective studies on radiation therapy for the management of metastatic lymph nodes from cutaneous melanoma have been published. This point of view is not shared by everyone. Use of radiation therapy for these patients has been hindered by the belief that melanoma is resistant to radiation. ![]() Although the role of radiotherapy in achieving locoregional control and palliation is recognised, it is not often used for the management of melanoma. ![]() ![]() Radiation therapy forms the third cornerstone of cancer management, together with surgery and systemic treatments. Inflammatory axillary nodal recurrence from cutaneous melanoma. Additional treatments are therefore needed to improve the patient's outcome for melanomas with a high risk of locoregional or distant recurrence. However, even with this approach, no survival benefit from SL with subsequent radical regional lymphadenectomy in malignant melanoma patients with lymph node (LN) metastases was found. The use of sentinel lymph node (SL) is gaining popularity in staging and treatment of patients with melanoma. Other ways to improve patients' survival have been explored in vain. Systemic therapies for metastatic patients have led to modest improvements in locoregional control or overall survival. While distant metastasis is often considered as the main factor for overall survival, regional control is still very important for the quality of life of these patients (figure (figure1). Despite appropriate excision, locally invasive melanomas bring risks of both local and distant relapses. Surgery is the main treatment for melanoma and has a central role in the management of many patients. The incidence of cutaneous melanoma is increasing in fair-skinned populations. ![]()
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