Lymph node dissection in patients with malignant melanoma is associated with high risk of morbidity

Abstract

Introduction: Malignant melanoma is one of the most rapidly increasing cancer types globally, and it is by far the most serious skin cancer. Patients with a melanoma ≥ 1 mm in Breslow thickness are offered sentinel node (SN) biopsy and subsequent radical lymph node dissection if the biopsy is positive. The objective in the present paper was to describe post-operative complications in this group of patients. A standard operation and drainage regime was used.

Material and methods: This was a retrospective study based on 96 consecutive SN-positive patients with primary cutaneous malignant melanoma who underwent subsequent radical axillary or inguinal lymph node dissection. Fisher's exact test and Mann-Whitney U-test were used to evaluate associations.

Results: In all, 57 patients were male and 39 female. A total of 71 had an axillary and 25 an inguinal operation. The median drainage period was seven days (2-15 days). Forty patients developed seroma which needed puncture; three of these cases were chronic, there was no difference between the two groups. Seroma puncture was only associated with infection in the inguinal group (p = 0.04). 25% in the axillary group were diagnosed with lymph oedema after three months versus 48% in the inguinal group (p = 0.04). A body mass index ≥ 25 kg/m2 was associated with a slight, but non-significant increase in complications (p = 0.08). No association was found for smoking or co-morbidity.

Conclusion: Patients undergoing axillary or inguinal lymph node dissection experience a significant number of complications, especially seroma and lymph oedema. Long-term complications are severe and can profoundly impact the patient's quality of life.