Surgical resection for bulky or recurrent axillary metastatic melanoma
Article first published online: 8 AUG 2011
Copyright © 2011 Wiley Periodicals, Inc.
Journal of Surgical Oncology
Volume 105, Issue 1, pages 21–25, January 2012
How to Cite
Shada, A. L., Walters, D. M., Tierney, S. N. and Slingluff, C. L. (2012), Surgical resection for bulky or recurrent axillary metastatic melanoma. J. Surg. Oncol., 105: 21–25. doi: 10.1002/jso.22058
- Issue published online: 6 DEC 2011
- Article first published online: 8 AUG 2011
- Manuscript Accepted: 18 JUL 2011
- Manuscript Received: 1 MAY 2011
- stage III;
- stage IV;
Metastatic melanoma has few FDA approved treatments, and aggressive surgical resection has to be considered for management of bulky axillary metastases. We hypothesized that axillary resection in this setting is well tolerated and improves symptoms in the majority of patients.
We reviewed a prospectively collected database and identified 47 stage IIIC and IV patients with axillary nodal disease greater than 5 cm (68%), recurrent disease (36%), or disease adherent to axillary neurovascular structures (45%). Paresthesias, pain, and bleeding were present in 40% of patients, and were stable or improved after surgery in 75%. Most patients were asymptomatic prior to resection, and underwent resection for prevention of potential symptoms.
Most patients underwent outpatient surgery. Postoperative complications included lymphedema (34%), range of motion limitation (23%), wound infection (17%), and neuropathic pain (17%). Among symptomatic patients, average time to progression was 3 months, compared to 9.5 months in asymptomatic patients (P = 0.08). Five-year survival was lower (16%) in symptomatic patients than in asymptomatic patients (35%, P = 0.001).
Surgery for bulky axillary melanoma metastases is well tolerated, and should be considered in the management of Stage III or IV melanoma. Resection prior to symptoms may improve quality of life and is associated with longer survival. J. Surg. Oncol. 2012; 105:21–25. © 2011 Wiley Periodicals, Inc.