title: Contemporary controversies and perspectives in the staging and treatment of patients with lymph node metastasis from melanoma, especially with regards positive sentinel lymph node biopsy.
abstract: The management of melanoma lymph node metastasis particularly when detected by sentinel lymph node biopsy (SLNB) is still controversial. Results of the only randomized trial conducted to assess the therapeutic value of SLNB, the Multicenter Selective Lymphadenectomy Trial (MSLT-1), have not conclusively proven the effectiveness of this procedure but are interpreted by the authors and guidelines as indicating SLNB is standard of care. After surgery, interferon alpha had a small survival benefit and radiotherapy has limited effectiveness for patient at high-risk of regional recurrence. New drugs, including immune modulating agents and targeted therapies, already shown to be effective in patients with distant metastasis, are being evaluated in the adjuvant setting. In this regard, ensuring high quality of surgery through the identification of reliable quality assurance indicators and improving the homogeneity of prognostic stratification of patients entered onto clinical trials is paramount. Here, we review the controversial issues regarding the staging and treatment of melanoma patients with lymph node metastasis, present a summary of important and potentially practice changing ongoing research and provide a commentary on what it all means at this point in time.
authors.affiliation: Department of Surgery, University Hospital of Birmingham, Edgbaston, Birmingham B15 2WB, UK.
authors.forename: Sandro
authors.initials: S
authors.lastname: Pasquali
authors.affiliation: Melanoma Institute Australia, Sydney, Australia; Mater Hospital North Sydney, 25 Rocklands Rd, Crows Nest 2065, Australia; Royal North Shore Hospital, Northern Sydney Cancer Centre, Reserve Rd, St Leonards, NSW 2065, Australia. Electronic address: andrew.spillane@melanoma.org.au.
authors.forename: Andrew
authors.initials: A
authors.lastname: Spillane
mesh_terms: D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008545:Melanoma / Q000473:pathology* / Q000628:therapy*; D015337:Multicenter Studies as Topic; D009367:Neoplasm Staging; D016032:Randomized Controlled Trials as Topic; D021701:Sentinel Lymph Node Biopsy / Q000379:methods* / Q000592:standards
keywords: Adjuvant; Lymph node; Lymphadenectomy; Melanoma; Sentinel lymph node; Staging