Metastatic melanoma (stage III) and lymph node dissection
at a university hospital facility
Ulrik K Kjerkegaard
Lars B Stolle
Received: 3 May 2016 /Accepted: 7 August 2016 /Published online: 16 August 2016
Springer-Verlag Berlin Heidelberg 2016
Background Malign melanoma continues to present a severe
health problem, and the incidence is still raising. Nodal status
and ulceration of the primary melanoma are strong prognostic
factors. The main treatment of node-positive melanomas
(stage III) is complete lymph node dissection. The aim of this
study was to describe the outcome in patients with stage III
melanoma who underwent completion lymphadenectomy at a
department of plastic surgery.
Methods Retrospectively, we included all patients who
underwent complete lymph node dissection in the period from
2008 to 2012 subsequent to a positive sentinel node biopsy or
palpable metastasis from a cutaneous malign melanoma.
Primary outcomes were disease-free survival and melanoma-
Results We included 150 patients with an average age of 57
(16–82) years. Melanoma thickness was 3.1 (0.53–15) mm.
Ulceration of primary tumor was present in 35 %. Complete
lymph node dissection was performed in the neck, axilla, in-
guinal region, and aberrant region. There was no difference in
occurrence of nodal metastases comparing the regions.
Seroma was most frequent in the axilla (23.5 %) and inguinal
region (18.9 %). Lymphedema occurred in the inguinal region
(15.1 %) and the axilla (4.7 %), and wound infection occurred
in the inguinal region (30.2 %), the axilla (15.3 %), and the
neck (11.1 %). The 5-year nodal recurrence rate was 16.9 %
[95 % CI 8.2–33.1 %] and the 5-year rate of distant metastases
was 48.3 % [95 % CI 36.5–61.8 %]. Overall survival was
51.8 % [95 % CI 35.6–65.8 %]. More than two nodal metas-
tases worsened the prognosis (reference: <2 lymph nodes).
Level of Evidence: Level IV, risk/prognostic study.
Keywords Stage III melanoma
Completion lymph node
Malign melanoma continues to present a severe health prob-
lem, and the incidence is still raising. According to the
Association of the Nordic Cancer Registries (NORDCAN),
the age-standardized incidence rate in Denmark was 25 per
100,000 in women and 20 per 100,000 in men in 2008 to 2012
. The mortality rate remains stable with an estimated annual
change of 1.0 % per year in men and 1.2 % in females, despite
the increasing incidence rate of melanoma with an estimated
annual change the latest 10 years of 6.7 % in men and 5.3 % in
females according to the NORDCAN melanoma registry.
Thus, the increased incidence rate is possibly explained by
an increased diagnostic rate of early-stage melanomas .
Nodal status and ulceration of the primary melanoma are
strong prognostic factors in patients without visceral metasta-
The main treatment of node-positive melanomas (stage III)
is surgical intervention in terms of complete lymph node dis-
section (CLND). Lymphadenectomy was, until the sentinel
lymph node biopsy (SLNB) was introduced in the 1990s,
the primary method for both diagnosis and curative treatment
in patients with nodal metastasis. Today, SLNB is the main
diagnostic method for nodal staging. In patients with a
* Ulrik K Kjerkegaard
Department of Plastic Surgery, Plastic Surgery Research Unit,
Aarhus University Hospital, Norrebrogade 44, 8000 Aarhus, DK,
Department of Plastic Surgery, Odense University Hospital, Sdr.
Boulevard 29, 5000 Odense C, Denmark
Eur J Plast Surg (2017) 40:127–132