BACKGROUND: Management of patients with sentinel lymph node (SLN)-positive melanoma has changed dramatically over the last few years such that completion lymph node dissection (CLND) has become uncommon, and many patients receive adjuvant immunotherapy or targeted therapy. This study seeks to characterize patterns and predictors of early recurrence in this setting. PATIENTS AND METHODS: All patients with primary cutaneous melanoma undergoing sentinel lymph node biopsy (SLNB) between 3/2016 and 12/2019 were identified. The subset with a positive SLN who did not undergo CLND were examined for further analysis of outcomes and predictors of recurrence. RESULTS: Overall, 215 patients with SLN-positive melanoma who did not have CLND were identified. Adjuvant systemic therapy was administered to 102 (47%), with 93% of this subset receiving immunotherapy (n = 95). Median follow-up from SLNB was 20 months (IQR 12-28.5 months), and 57 patients (27%) recurred during this time. The SLN basin was the most common site of recurrence (n = 38, 67% of recurrence), with isolated nodal recurrence being the most common first site of recurrent disease (n = 22, 39% of recurrence). On multivariable analysis, lymphovascular invasion (LVI) of the primary tumor, two or more involved nodes, and > 1 mm nodal deposit were independently associated with higher rates of nodal relapse. CONCLUSIONS: Nodal recurrence is a primary driver of early disease relapse for patients with SLN-positive melanoma who do not undergo CLND in the era of effective adjuvant systemic therapy. LVI, ≥ 2 nodes, or > 1 mm nodal disease identifies patients at particularly high risk of nodal relapse.
BACKGROUND: Management of patients with sentinel lymph node (SLN)-positive melanoma has changed dramatically over the last few years such that completion lymph node dissection (CLND) has become uncommon, and many patients receive adjuvant immunotherapy or targeted therapy. This study seeks to characterize patterns and predictors of early recurrence in this setting. PATIENTS AND METHODS: All patients with primary cutaneous melanoma undergoing sentinel lymph node biopsy (SLNB) between 3/2016 and 12/2019 were identified. The subset with a positive SLN who did not undergo CLND were examined for further analysis of outcomes and predictors of recurrence. RESULTS: Overall, 215 patients with SLN-positive melanoma who did not have CLND were identified. Adjuvant systemic therapy was administered to 102 (47%), with 93% of this subset receiving immunotherapy (n = 95). Median follow-up from SLNB was 20 months (IQR 12-28.5 months), and 57 patients (27%) recurred during this time. The SLN basin was the most common site of recurrence (n = 38, 67% of recurrence), with isolated nodal recurrence being the most common first site of recurrent disease (n = 22, 39% of recurrence). On multivariable analysis, lymphovascular invasion (LVI) of the primary tumor, two or more involved nodes, and > 1 mm nodal deposit were independently associated with higher rates of nodal relapse. CONCLUSIONS: Nodal recurrence is a primary driver of early disease relapse for patients with SLN-positive melanoma who do not undergo CLND in the era of effective adjuvant systemic therapy. LVI, ≥ 2 nodes, or > 1 mm nodal disease identifies patients at particularly high risk of nodal relapse.
Authors: John F Thompson; Seng-Jaw Soong; Charles M Balch; Jeffrey E Gershenwald; Shouluan Ding; Daniel G Coit; Keith T Flaherty; Phyllis A Gimotty; Timothy Johnson; Marcella M Johnson; Stanley P Leong; Merrick I Ross; David R Byrd; Natale Cascinelli; Alistair J Cochran; Alexander M Eggermont; Kelly M McMasters; Martin C Mihm; Donald L Morton; Vernon K Sondak Journal: J Clin Oncol Date: 2011-04-25 Impact factor: 44.544
Authors: Alexander M M Eggermont; Christian U Blank; Mario Mandala; Georgina V Long; Victoria Atkinson; Stéphane Dalle; Andrew Haydon; Mikhail Lichinitser; Adnan Khattak; Matteo S Carlino; Shahneen Sandhu; James Larkin; Susana Puig; Paolo A Ascierto; Piotr Rutkowski; Dirk Schadendorf; Rutger Koornstra; Leonel Hernandez-Aya; Michele Maio; Alfonsus J M van den Eertwegh; Jean-Jacques Grob; Ralf Gutzmer; Rahima Jamal; Paul Lorigan; Nageatte Ibrahim; Sandrine Marreaud; Alexander C J van Akkooi; Stefan Suciu; Caroline Robert Journal: N Engl J Med Date: 2018-04-15 Impact factor: 91.245
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: Sandra L Wong; Mark B Faries; Erin B Kennedy; Sanjiv S Agarwala; Timothy J Akhurst; Charlotte Ariyan; Charles M Balch; Barry S Berman; Alistair Cochran; Keith A Delman; Mark Gorman; John M Kirkwood; Marc D Moncrieff; Jonathan S Zager; Gary H Lyman Journal: Ann Surg Oncol Date: 2017-12-13 Impact factor: 5.344
Authors: Jeffrey Weber; Mario Mandala; Michele Del Vecchio; Helen J Gogas; Ana M Arance; C Lance Cowey; Stéphane Dalle; Michael Schenker; Vanna Chiarion-Sileni; Ivan Marquez-Rodas; Jean-Jacques Grob; Marcus O Butler; Mark R Middleton; Michele Maio; Victoria Atkinson; Paola Queirolo; Rene Gonzalez; Ragini R Kudchadkar; Michael Smylie; Nicolas Meyer; Laurent Mortier; Michael B Atkins; Georgina V Long; Shailender Bhatia; Celeste Lebbé; Piotr Rutkowski; Kenji Yokota; Naoya Yamazaki; Tae M Kim; Veerle de Pril; Javier Sabater; Anila Qureshi; James Larkin; Paolo A Ascierto Journal: N Engl J Med Date: 2017-09-10 Impact factor: 91.245
Authors: Georgina V Long; Axel Hauschild; Mario Santinami; Victoria Atkinson; Mario Mandalà; Vanna Chiarion-Sileni; James Larkin; Marta Nyakas; Caroline Dutriaux; Andrew Haydon; Caroline Robert; Laurent Mortier; Jacob Schachter; Dirk Schadendorf; Thierry Lesimple; Ruth Plummer; Ran Ji; Pingkuan Zhang; Bijoyesh Mookerjee; Jeff Legos; Richard Kefford; Reinhard Dummer; John M Kirkwood Journal: N Engl J Med Date: 2017-09-10 Impact factor: 91.245
Authors: Alexander M M Eggermont; Christian U Blank; Mario Mandala; Georgina V Long; Victoria G Atkinson; Stéphane Dalle; Andrew M Haydon; Andrey Meshcheryakov; Adnan Khattak; Matteo S Carlino; Shahneen Sandhu; James Larkin; Susana Puig; Paolo A Ascierto; Piotr Rutkowski; Dirk Schadendorf; Rutger Koornstra; Leonel Hernandez-Aya; Anna Maria Di Giacomo; Alfonsus J M van den Eertwegh; Jean-Jacques Grob; Ralf Gutzmer; Rahima Jamal; Paul C Lorigan; Alexander C J van Akkooi; Clemens Krepler; Nageatte Ibrahim; Sandrine Marreaud; Michal Kicinski; Stefan Suciu; Caroline Robert Journal: J Clin Oncol Date: 2020-09-18 Impact factor: 44.544