Videoscopic Inguinal Lymphadenectomy for Metastatic Melanoma

Benjamin M. Martin, MD; Viraj A. Master, MD, PhD; Keith A. Delman, MD

Disclosures

Cancer Control. 2013;20(4):255-260. 

In This Article

Abstract and Introduction

Abstract

Background: The standard treatment of care for melanoma metastatic to the inguinal lymph node basin is lymphadenectomy. However, up to 50% of patients forgo the operation partly due to concerns about morbidity. Videoscopic inguinal lymphadenectomy (VIL) is a minimally invasive technique designed to minimize wound complications while achieving comparable oncological control.

Methods: We reviewed pertinent literature related to open inguinal lymphadenectomy and VIL specific to melanoma, offering personal experience where appropriate.

Results: Despite efforts to minimize the complications of open inguinal lymphadenectomy, approximately 50% of patients experience a wound-related complication. However, performing minimally invasive VIL has led to a significant decrease in length of hospital stay, a decrease in complications, and equivalent or superior lymph node retrieval in patients with metastatic melanoma to the inguinal basin.

Conclusions: VIL is an alternative to open inguinal lymphadenectomy for patients with melanoma and regional metastases.

Introduction

The incidence of melanoma, a malignancy of pigment-producing melanocytes located predominantly within the skin, is increasing in frequency. The lifetime risk of developing melanoma in the United States is 1 in 63, an increase of approximately 270% over approximately 35 years.[1] A portion of this increase may be attributable to heightened societal awareness and more aggressive detection; however, most is considered to be the result of factors such as increased natural or artificial ultraviolet light exposure and habits surrounding their use.

For patients with early-stage melanoma, the most important prognostic factor is the presence or absence of metastatic regional disease. When regional disease was clinically apparent or microscopically identified during sentinel lymph node biopsy, early detection and complete lymphadenectomy enhanced survival, especially in patients with intermediate-thickness primary lesions.[2] One can extrapolate the implication that dissection of a nodal basin alone may beneficially impact survival; however, such an implication has not been completely addressed. In the setting of node-positive disease, complete lymphadenectomy remains the standard of care and is recommended by the National Comprehensive Cancer Network.[3] Despite this, up to 50% of patients with positive sentinel lymph nodes forgo complete lymphadenectomy,[4] most likely due to the high morbidity associated with open lymphadenectomy (eg, wound-related complications).

Videoscopic inguinal lymphadenectomy (VIL) is a minimally invasive alternative to traditional open lymphadenectomy for regional metastases to the inguinal lymph nodes. The technique maintains an oncologically sound dissection of the lymph node packet while also minimizing wound-related morbidity. An adaption of the technique was originally described by Tobias-Machado et al[5] for use in patients with genitourinary malignancies, which we reported elsewhere.[6] In this article, we review a step-wise approach to the procedure.

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