Is a level III dissection necessary for a positive sentinel lymph node in melanoma?

BACKGROUND For melanoma patients with a positive axillary SLN, the extent of ALND remains controversial, with debate over whether a level III dissection is needed. METHODS We queried our IRB approved prospective database for patients with a positive axillary SLN who had a level I/II dissection only, and compared recurrence and complication rates to the existing literature. RESULTS Between 1998 and 2008, 270 patients had 285 level I/II ALNDs for a positive SLN. Median number of SLN removed was 2, while the median number of involved SLN was 1 (range 1-4). An average of 18.7 nodes/ALND were removed, with 13% having positive non-SLN. Post-operative complications occurred in 31 patients (11%), primarily cellulitis (8%). After a mean follow-up of 44 months, 14 patients had a regional recurrence in the axillary basin (5%). CONCLUSIONS The complication rate and regional recurrence rate for patients undergoing a level I/II ALND for a positive SLN are either lower than or on par with reported series of ALND for level I, II, and III dissections, suggesting that in this setting, the level III dissection may be of minimal benefit.