What is elective lymph node dissection (ELND)? When is it indicated?

ELND is the dissection of the draining lymph node basin in patients with deep primary melanomas who are felt to be at high risk for development of metastasis to the lymph nodes. ELND is based on the notion that melanoma cells migrate in an orderly fashion toward the draining lymph node. Therefore, surgical excision of all involved nodes in patients with stage III disease was postulated to prevent the spread of tumor to other organs. However, five multicenter randomized prospective trials in patients with primary melanoma have not shown a survival benefit for patients treated with ELND plus wide excision as compared to wide excision alone. Most large melanoma centers do not routinely perform ELND.

Balch CM, Cascinelli N, Sim FH, et al: Elective lymph node dissection: results of a prospective randomized surgical trial. In Balch CM, Houghton AN, Sober AJ, Soong S-J, editors: Cutaneous melanoma, ed 3, St Louis, Quality Medical Publishing, 1998, pp 209–215.


Medalie NS, Ackerman AB: Sentinel lymph node biopsy has no benefit for patients with primary cutaneous melanoma metastatic to a lymph node: an assertion based on comprehensive, critical analysis: part I, Am J Dermatopathol 25:399–417, 2003.

Medalie NS, Ackerman AB: Sentinel lymph node biopsy has no benefit for patients with primary cutaneous melanoma metastatic to a lymph node: an assertion based on comprehensive, critical analysis: part II, Am J Dermatopathol 25:473–484, 2003.