Surgical Technique and Indications for Radical Dissection: Axilla

Abstract

The main purpose of lymphadenectomy in patients affected by lymph node metastases from melanoma is to provide locoregional control of disease. It is indicated for patients with histo- and/or cytologically proven lymph node metastases and has also an important role in patients’ staging. Lymph node involvement is diagnosed in different ways, most frequently after sentinel lymph node biopsy (SLNB) but a proportion of patients may present clinical evident metastases at diagnosis or during the follow-up. A randomized clinical trial, MSLTII, has recently shown that immediate completion lymph node dissection (CLND) increases the rate of regional disease control and provides prognostic information but does not increase melanoma-specific survival. At present, ASCO recommends that in the case of a positive SLNB, CLND or careful observation can be an option for patients with low risk micrometastatic disease. For higher-risk patients, careful observation may be considered only after a through discussion with the patients about the potential risks and benefits of foregoing CLND. After axillary lymph node dissection, the most common complications are: seromas, wound infections, severe nerve dysfunction with pain, hemorrhage, skin necrosis, lymphedema. The complication rates and oncological outcomes can be seen as indicators for quality assurance of lymph node dissection.