Axillary node dissection in malignant melanoma.
Axillary node dissection was performed in 212 patients with malignant melanoma. For 212 initial dissections plus 49 repeat procedures (261 operations), wound infection occurred in 25 (10%) and arm edema in 10 (4%), with other complications being infrequent. The arm edema resolved promptly and completely six (2%) patients after elevation of the arm, while four (2%) patients have had permanent, moderate edema. The estimated 5-year survival rate for patients with clinically and histologically negative nodes was 74%. Among those with histologically positive nodes, when the nodes were not palpable, this rate was 73%; when the nodes were palpable and less than 2 cm in diameter, it was 46%; when they were palpable and 2 to 4 cm in diameter, it was 22%; when the nodes were larger than 4 cm in diameter, it was 18%; and when the nodes were fixed, it was 13%. The 5-year survival rate for 17 patients with positive nodes above the level of the axillary vein was 18%; 1 of 6 patients with resection of the axillary vein due to involvement is disease-free 57 months later. In patients who developed recurrence, further resection when feasible resulted in 13% of these patients being disease-free 5 years after the original axillary dissection.