BACKGROUND: Completion lymph node dissection (CLND) is considered the standard of care in melanoma patients found to have sentinel lymph node (SLN) metastasis. However, the therapeutic utility of CLND is not known. The natural history of patients with positive SLNs who do not undergo CLND is undefined. This multi-institutional study was undertaken to characterize patterns of failure and survival rates in these patients and to compare results with those of positive-SLN patients who underwent CLND. METHODS: Surgeons from 16 centers contributed data on 134 positive-SLN patients who did not undergo CLND. SLN biopsy was performed by using each institution's established protocols. Patients were followed up for recurrence and survival. RESULTS: In this study population, the median age was 59 years, and 62% were male. The median tumor thickness was 2.6 mm, 77% of tumors had invasion to Clark level IV/V, and 33% of lesions were ulcerated. The primary melanoma was located on the extremities, trunk, and head/neck in 45%, 43%, and 12%, respectively. The median follow-up was 20 months. The median time to recurrence was 11 months. Nodal recurrence was a component of the first site of recurrence in 20 patients (15%). Nodal recurrence-free survival was statistically insignificantly worse than that seen in a contemporary cohort of patients who underwent CLND. Disease-specific survival for positive-SLN patients who did not undergo CLND was 80% at 36 months, which was not significantly different from that of patients who underwent CLND. CONCLUSIONS: This study underscores the importance of ongoing prospective randomized trials in determining the therapeutic value of CLND after positive SLN biopsy in melanoma patients.
BACKGROUND: Completion lymph node dissection (CLND) is considered the standard of care in melanomapatients found to have sentinel lymph node (SLN) metastasis. However, the therapeutic utility of CLND is not known. The natural history of patients with positive SLNs who do not undergo CLND is undefined. This multi-institutional study was undertaken to characterize patterns of failure and survival rates in these patients and to compare results with those of positive-SLN patients who underwent CLND. METHODS: Surgeons from 16 centers contributed data on 134 positive-SLN patients who did not undergo CLND. SLN biopsy was performed by using each institution's established protocols. Patients were followed up for recurrence and survival. RESULTS: In this study population, the median age was 59 years, and 62% were male. The median tumor thickness was 2.6 mm, 77% of tumors had invasion to Clark level IV/V, and 33% of lesions were ulcerated. The primary melanoma was located on the extremities, trunk, and head/neck in 45%, 43%, and 12%, respectively. The median follow-up was 20 months. The median time to recurrence was 11 months. Nodal recurrence was a component of the first site of recurrence in 20 patients (15%). Nodal recurrence-free survival was statistically insignificantly worse than that seen in a contemporary cohort of patients who underwent CLND. Disease-specific survival for positive-SLN patients who did not undergo CLND was 80% at 36 months, which was not significantly different from that of patients who underwent CLND. CONCLUSIONS: This study underscores the importance of ongoing prospective randomized trials in determining the therapeutic value of CLND after positive SLN biopsy in melanomapatients.
Authors: Sandra L Wong; Charles M Balch; Patricia Hurley; Sanjiv S Agarwala; Timothy J Akhurst; Alistair Cochran; Janice N Cormier; Mark Gorman; Theodore Y Kim; Kelly M McMasters; R Dirk Noyes; Lynn M Schuchter; Matias E Valsecchi; Donald L Weaver; Gary H Lyman Journal: J Clin Oncol Date: 2012-07-09 Impact factor: 44.544
Authors: F Egberts; C Hartje; C Schafmayer; K C Kaehler; W von Schönfels; A Hauschild; T Becker; J H Egberts Journal: Ann R Coll Surg Engl Date: 2011-10 Impact factor: 1.891
Authors: Mark B Faries; John F Thompson; Alistair J Cochran; Robert H Andtbacka; Nicola Mozzillo; Jonathan S Zager; Tiina Jahkola; Tawnya L Bowles; Alessandro Testori; Peter D Beitsch; Harald J Hoekstra; Marc Moncrieff; Christian Ingvar; Michel W J M Wouters; Michael S Sabel; Edward A Levine; Doreen Agnese; Michael Henderson; Reinhard Dummer; Carlo R Rossi; Rogerio I Neves; Steven D Trocha; Frances Wright; David R Byrd; Maurice Matter; Eddy Hsueh; Alastair MacKenzie-Ross; Douglas B Johnson; Patrick Terheyden; Adam C Berger; Tara L Huston; Jeffrey D Wayne; B Mark Smithers; Heather B Neuman; Schlomo Schneebaum; Jeffrey E Gershenwald; Charlotte E Ariyan; Darius C Desai; Lisa Jacobs; Kelly M McMasters; Anja Gesierich; Peter Hersey; Steven D Bines; John M Kane; Richard J Barth; Gregory McKinnon; Jeffrey M Farma; Erwin Schultz; Sergi Vidal-Sicart; Richard A Hoefer; James M Lewis; Randall Scheri; Mark C Kelley; Omgo E Nieweg; R Dirk Noyes; Dave S B Hoon; He-Jing Wang; David A Elashoff; Robert M Elashoff Journal: N Engl J Med Date: 2017-06-08 Impact factor: 91.245
Authors: Hayley Standage; Alyssa R Hersh; Aaron Caughey; Matthew Taylor; John Vetto; Dale Han Journal: Ann Surg Oncol Date: 2020-09-19 Impact factor: 5.344