To analyze the outcome after adjuvant radiation therapy with standard fractionation regimen in metastatic lymph nodes (LN) from cutaneous melanoma.

86 successive patients (57 men) were treated for locally advanced melanoma in our institution. 60 patients (70%) underwent LN dissection followed by radiation therapy (RT) while 26 patients (30%) have had no radiotherapy.

Median number of resected LN was 12 (1 to 36) with 2 metastatis (1 to 28). Median survival after the first relapse was 31.8 months. Extracapsular extension was a significant prognostic factor for local control (p=0.019). Median total dose was 50 Gy (30 to 70 Gy). A standard fractionation regimen was used (2 Gy/fraction). Median number of fractions was 25 (10 to 44 fractions). Patients were treated with five fractions/week. Patients with extracapsular extension treated with surgery followed by RT (total dose [greater than or equal to]50 Gy) had a better local control than patients treated by surgery followed by RT with a total dose < 50 Gy (80% vs 35% at 5 years follow-up; p=0.004).

Adjuvant radiotherapy could increase local control in targeted sub-population (LN with extracapsular extension). Total dose delivered should be greater than 50 Gy.

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