Lymphadenectomy for melanoma in the clinically N1 neck: radical, modified radical, or selective?

The purpose of a neck dissection is to control the disease in the neck and has little influence on long-term survival. Radical neck dissection leads to significant morbidity; this morbidity is decreased in modified radical neck dissections and reduced even further in selective dissections. An analysis was made of 37 consecutive patients with melanoma for an 8-year period presenting with a clinically N1 neck (a single involved node based on clinical examination and radiologic investigation). Six patients underwent radical, 24 modified radical, and 7 selective neck dissections. There was a mean follow-up of 3 years 10 months after primary diagnosis. Minimum follow-up after lymphadenectomy was 18 months, and at this point, there were no cases of local recurrence (neck failure) in any of the survivors in the 3 groups. In our series, there was no difference in locoregional control for the 3 groups. We would recommend a modified radical neck dissection for the N1 neck in melanoma with an intraoperative decision being made on which structures to preserve based on position of involved lymph node and adjacent structures, particularly in younger patients. A selective neck dissection should be considered in those patients with significant comorbidity, distant metastatic disease, or primary sites on the back or posterior scalp.