Melanoma patients with positive sentinel nodes who did not undergo completion lymphadenectomy: a multi-institutional study.
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.
Wong
Sandra L
SL
Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, USA.
Morton
Donald L
DL
Thompson
John F
JF
Gershenwald
Jeffrey E
JE
Leong
Stanley P L
SP
Reintgen
Douglas S
DS
Gutman
Haim
H
Sabel
Michael S
MS
Carlson
Grant W
GW
McMasters
Kelly M
KM
Tyler
Douglas S
DS
Goydos
James S
JS
Eggermont
Alexander M M
AM
Nieweg
Omgo E
OE
Cosimi
A Benedict
AB
Riker
Adam I
AI
G Coit
Daniel
D
D015331:Cohort Studies; D005121:Extremities / Q000473:pathology; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy / Q000379:methods; D012878:Skin Neoplasms / Q000556:secondary* / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome