The surgical treatment of a melanoma patient with macroscopic metastasis in peri and retrocaval lymph nodesand with a positive sentinel lymph node in the groin


COD: 2476_04_02_2016_ep Categorie: , ,

Giuseppe Giudice, Fabio Robusto, Eleonora Nacchiero

Ann. Ital. Chir.Published online (EP) 4 February 2016

La mia nuova descrizione qui!

Price of a print issue €25.00
BACKGROUND: The extension of iliac-obturator dissection in melanoma patient with metastatic sentinel node of the groinis very debated. More recent studies – in accord with guidelines for urogenital cancers – suggest the extension to pelviclymph nodes. At present, however, anatomical limits and indications to pelvic dissection are not defined in melanomapatients with metastatic lymph nodes of groin.
CASEREPORT: A 46-year-old man affected by nodular cutaneous melanoma (Breslow-thickness 10 mm, Clark-level V)on the anterior-medial surface of the right leg underwent sentinel node biopsy of groin. Three macro-metastatic sentinellymph nodes were removed in right inguinal field and, after 2 weeks, an ipsi-lateral inguinal lymphadenectomy withan extended pelvic dissection was performed. During the surgery, we reported the presence of macrometastases also inretro/peri caval lymph nodes. As a result of these findings, we decided to perform the super-extended pelvic lymphadenectomy. Overall we removed 56 lymph nodes with 9 peri-caval and 2 retro-caval macro metastatic lymph nodes. After a peri-od of 49 months, the patients came to our attention with multiple scrotal metastases. The imagining restaging of thepatient was already negative for other melanoma localizations.
DISCUSSION: Currently there are no guidelines about indications and anatomical limits of iliac-obturator extension inmelanoma patients. The extended pelvic dissection is the gold-standard procedure used in urogenital carcinomas. In caseof finding of macro-metastases during the surgical procedure, the approach to follow is even more uncertain. We per-form a super-extended pelvic dissection with a good prognosis for the patient.