title: Impact of Completion Lymph Node Dissection on Patients with Positive Sentinel Lymph Node Biopsy in Melanoma.
abstract: Whether patients with positive SLNB should undergo complete lymph node dissection (CLND) is an important unanswered clinical question.
  
  
  
  Patients diagnosed with positive SLNB at a melanoma referral center from 1991 to 2013 were studied. Outcomes of patients who underwent CLND were compared with those who did not undergo immediate CLND (observation [OBS] group).
  
  
  
  There were 471 patients who had positive SLNB; 375 (79.6%) in the CLND group and 96 (20.4%) in the OBS group. The groups were similar except that the CLND group was younger and had more sentinel nodes removed. Five-year nodal recurrence-free survival was significantly better in the CLND group compared with the OBS group (93.1% vs 84.4%; p = 0.005). However, 5-year (66.4% vs 55.2%) and 10-year (59.5% vs 45.0%) distant metastasis-free survival rates were not significantly different (p = 0.061). The CLND group's melanoma-specific survival (MSS) rate was superior to that of the OBS group; 5-year MSS rates were 73.7% vs 65.5% and 10-year MSS rates were 66.8% vs 48.3% (p = 0.015). On multivariate analysis, CLND was associated with improved MSS (hazard ratio = 0.60; 95% CI, 0.40-0.89; p = 0.011) and lower nodal recurrence (hazard ratio = 0.46; 95% CI, 0.24-0.86; p = 0.016). Increased Breslow thickness, older age, ulceration, and trunk melanoma were all associated with worse outcomes. On subgroup analysis, the following factors were associated with better outcomes from CLND: male sex, nonulcerated primary, intermediate thickness, Clark level IV or lower extremity tumors.
  
  
  
  Treatment of positive SLNB with CLND was associated with improved MSS and nodal recurrence rates. Follow-up beyond 5 years was needed to see a significant difference in MSS rates.
authors.affiliation: Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St John's Health Center, Santa Monica, CA.
authors.forename: David Y
authors.initials: DY
authors.lastname: Lee
authors.affiliation: Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St John's Health Center, Santa Monica, CA.
authors.forename: Briana J
authors.initials: BJ
authors.lastname: Lau
authors.affiliation: Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St John's Health Center, Santa Monica, CA.
authors.forename: Kelly T
authors.initials: KT
authors.lastname: Huynh
authors.affiliation: Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St John's Health Center, Santa Monica, CA.
authors.forename: Devin C
authors.initials: DC
authors.lastname: Flaherty
authors.affiliation: Department of Biostatistics, The John Wayne Cancer Institute at Providence St John's Health Center, Santa Monica, CA.
authors.forename: Ji-Hey
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Biostatistics, The John Wayne Cancer Institute at Providence St John's Health Center, Santa Monica, CA.
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Stern
authors.affiliation: Department of Medical Oncology, The John Wayne Cancer Institute at Providence St John's Health Center, Santa Monica, CA.
authors.forename: Steve J
authors.initials: SJ
authors.lastname: O'Day
authors.affiliation: Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St John's Health Center, Santa Monica, CA.
authors.forename: Leland J
authors.initials: LJ
authors.lastname: Foshag
authors.affiliation: Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St John's Health Center, Santa Monica, CA. Electronic address: mark.faries@jwci.org.
authors.forename: Mark B
authors.initials: MB
authors.lastname: Faries
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D000071036:Sentinel Lymph Node / Q000473:pathology* / Q000601:surgery; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult