Observation After a Positive Sentinel Lymph Node Biopsy in Patients with Melanoma

Abstract

The benefit of completion lymph node dissection (CLND) in melanoma patients with a positive sentinel lymph node (SLN) remains unknown. We identified patients with a positive SLN from 1994 to 2012. Patient and tumor characteristics, reasons for not undergoing CLND, patterns of recurrence, and melanoma-specific survival data were analyzed. Of 4,310 patients undergoing SLN biopsy (SLNB), 495 (11 %) had a positive SLN—167 (34 %) patients underwent nodal observation and 328 (66 %) had immediate CLND. Patients in the no-CLND group were older (66 vs. 56 years; p < 0.001) and more likely to have lower extremity lesions (57 vs. 42 %; p = 0.006). There were no differences in tumor thickness, Clark level of invasion, ulceration, or SLN tumor burden. Median follow-up was 23 and 80 months for the no-CLND and CLND groups, respectively, and median time to recurrence was similar at 9 and 12 months, respectively (p = 0.48). There was no difference in local and in transit recurrence rates between groups (16 %, no CLND, and 18 %, CLND; p = 0.48). Nodal disease as a site of first recurrence occurred in 15 % of patients in the no-CLND group and 6 % of CLND patients (p = 0.002). In contrast, systemic recurrences occurred in 8 % of no-CLND patients compared with 27 % of CLND patients (p < 0.001). While median recurrence-free survival was higher after CLND (34.5 vs. 20.9 months; p = 0.02), melanoma-specific survival was similar (not reached, no CLND vs. 110 months, CLND; p = 0.09). Immediate CLND after a positive SLNB is associated with fewer initial nodal basin recurrences but similar melanoma-specific survival. These results support ongoing equipoise in the Multicenter Selective Lymphadenectomy Trial II (MSLT-II).

DOI: 10.1245/s10434-014-3758-7

5 Figures and Tables

050100201520162017
Citations per Year

91 Citations

Semantic Scholar estimates that this publication has 91 citations based on the available data.

See our FAQ for additional information.

Cite this paper

@article{Bamboat2014ObservationAA, title={Observation After a Positive Sentinel Lymph Node Biopsy in Patients with Melanoma}, author={Zubin M. Bamboat and Ioannis T Konstantinidis and Deborah Kuk ScM and PhD Charlotte E. Ariyan and Mary Sue Brady and Daniel G. Coit}, journal={Annals of Surgical Oncology}, year={2014}, volume={21}, pages={3117-3123} }