Staging laparotomy in the treatment of metastatic melanoma of the lower extremities.

Twenty-six consecutive patients with melanoma of the lower extremities metastatic to the superficial inguinal lymph nodes were subjected to laparotomy. No patient had preoperative evidence of tumor dissemination past the superficial inguinal nodes. However three patients (12%) had metastases to the liver or para-aortic lymph nodes documented at laparotomy and were not subjected to iliac and obturator lymph node dissection. One of these patients had concomitant local recurrence of melanoma at the ankle. The other two patients had superficial inguinal lymph nodes at least 5 cm in diameter, although two other such patients with similar 5 cm lymph nodes did not have positive intra-abdominal findings. The remaining 23 of the 26 patients underwent ipsilateral iliac and obturator lymph node dissection, which proved positive in 3/23 patients (13%). Of these 23 patients undergoing iliac and obturator node dissection, 18 had clinically positive (and microscopically positive) superficial inguinal nodes prior to their dissection, while the remaining 5 patients had clinically negative (but microscopically positive) superficial inguinal nodes. The three cases of positive dissected iliac and obturator nodes occurred among the 18 patients with clinically positive superficial inguinal nodes (17%). Among the 5 patients with clinically negative, microscopically positive superficial groin nodes, there was no detectable deep inguinal nodal spread (or hepatic or para-aortic involvement).