Elective lymph node dissection in stage I malignant melanoma: a meta-analysis.

The role of elective lymph node dissection (ELND) in stage I melanoma has been a controversial issue for decades. Numerous studies have been conducted to try to establish the benefit of ELND versus wide local excision (WLE). The majority of these studies suggest no significant difference in survival, although some investigations have shown ELND to be of benefit in intermediate thickness (0.76-3.99 mm) melanomas. In order to resolve this ongoing controversy, a meta-analysis was undertaken to review and analyse the results of previous reports. There was a total of 10,132 patients of whom 3,409 in 15 studies underwent ELND for all melanoma patients and 3,618 patients of whom 1,336 in eight studies had ELND for intermediate thickness (0.76-3.99) melanomas. No significant 5-year survival was present in all patients treated with ELND (p > 0.05, confidence intervals -0.0780, 0.0788), however, a significant 5-year survival was found in the intermediate thickness subgroup (p < 0.0001, confidence intervals -0.02, 0.22). Therefore, ELND may be valuable for improving the prognosis of patients with intermediate thickness melanomas.