Inguinal Lymph Node Dissection for Advanced Stages of Plantar Melanoma in a Low-Income Country.

Background: Advanced stages of plantar acral lentiginous melanoma are common in Africa. Inguinal lymph node dissection (ILND) in these cases plays a critical role in disease-free and overall survival. Our study aims to share our experience in ILND for advanced plantar melanomas. Methods and Study Design . Four-year prospective study. Patients . We included all documented cases of advanced stage plantar melanoma with clinically detectable inguinal lymph node metastasis. Twenty-two of 27 patients identified-with mean age 56 years-underwent ILND. Studied Variables. Tumor patterns and stage, surgery, morbidity, oncologic pathology, and evolution were studied. Statistical software assessed the overall survival (OS).

Results: Plantar lesions were all excised with a cancer-free margin (3 cm). ILND was performed for 22 patients with visible ( n  = 11), palpable ( n  = 7), and ulcerous ( n  = 4) lymphadenopathies. It was performed through an S-shaped ( n  = 11) or ellipse-shaped skin incision ( n  = 11). The tumors were AJCC stage III ( n  = 18) and IV ( n  = 2). We found high Breslow index tumor thickness (>3 mm) and an advanced Clark IV stage ( n  = 20). All operative wounds healed within 46 days (21-90). Wound healing was delayed by suture failure ( n  = 16), lymphorrhoea ( n  = 22), and infection ( n  = 18). After 29 months, three patients had complete remissions, seven had recurrences, and twelve patients had died. The overall survival (OS) at one year was 56%. In two patients with AJCC stage III disease, the OS was better (22 months).

Conclusion: In low-income countries, ILND in advanced stages of plantar foot melanoma is a valuable surgical treatment option. Alongside ILND adjuvants, treatment must be available and accessible to improve survival.