Melanoma metastatic to cervical lymph nodes: Can radiotherapy replace formal dissection after local excision of nodal disease?

Background. Completion cervical lymphadenectomy is usually performed after excisional biopsy of nodal metastases from melanoma. Radiation (XRT) might be effective for some patients in lieu of formal lymph node dissection. Methods. Thirty-six patients with parotid or cervical node metastases from melanoma were treated with excision of nodal disease and postoperative XRT without formal lymph node dissection. Radiation was delivered to the primary site (if known), the site of nodal excision, and the undissected ipsilateral neck. Results. With a median follow-up of 5.3 years, the disease recurred within the regional basin in two patients and at distant sites in 14 patients. The actuarial 5-year regional control and distant metastasis-free survival rates were 93% and 59%, respectively. Two patients had a clinically significant side effect develop. Conclusions. The results of this study suggest that selected patients may receive regional XRT after local excision of nodal disease from melanoma in lieu of formal lymph node dissection. (c) 2005 Wiley Periodicals, Inc.