Features of Lymphatic Surgery in Patients with Cutaneous Melanoma

Introduction. Cutaneous melanoma is an aggressive malignant tumor of neuroectodermal origin. According to statistics, most patients begin treatment at stages 2 and 3 of the disease. This worsens the prognosis and determines the need for expanding the scope of surgical treatment. Aim: To improve the outcomes of lymphatic surgery in patients with cutaneous melanoma. Materials and methods. A total of 190 medical records of cutaneous melanoma patients is analyzed. The feasibility of escalation and de-escalation of interventions is statistically assessed. The formed prospective sample includes 43 stage 3 patients subjected to surgery by intraoperative lymphorrhea-preventing methods. Results and discussion. Prophylactic lymphadenectomy appears nonoptimal since most patients have no evidence of lymph node involvement at the time of surgery. Refusal to perform an extended intervention scarcely ever meet the requirements of oncological safety. Of 43 patients with metastatic lymph node involvement, 25 persons had involvement of only one lymph node; two or more lymph nodes were involved in 18 patients. If lymphadenectomy is not performed, a high risk of recurrence is possible in 41% of patients. Patients with stage 1 cutaneous melanoma observe a low percentage of both lymph collector damage and regional metastasis in the distant period. Stage 3 patients have an increased risk of postoperative adverse events. Sealing of lymphatic vessels, careful treatment of surrounding structures, as well as the use of optical magnification show good results in the prevention of postoperative lymphorrhea to reduce the risk of other complications. Conclusion. The type of surgical intervention in patients with cutaneous melanoma should be based on prognose analysis, considered in accordance with possible risks and, if necessary, supplemented by the use of means to prevent complications.

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