Observation after a positive sentinel lymph node biopsy in patients with melanoma Journal Article

Authors: Bamboat, Z. M.; Konstantinidis, I. T.; Kuk, D.; Ariyan, C. E.; Brady, M. S.; Coit, D. G.
Article Title: Observation after a positive sentinel lymph node biopsy in patients with melanoma
Abstract: Background. The benefit of completion lymph node dissection (CLND) in melanoma patients with a positive sentinel lymph node (SLN) remains unknown. Methods. 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. Results. 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). Conclusions. 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). © 2014 Society of Surgical Oncology.
Journal Title: Annals of Surgical Oncology
Volume: 21
Issue: 9
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2014-09-01
Start Page: 3117
End Page: 3123
Language: English
DOI: 10.1245/s10434-014-3758-7
PROVIDER: scopus
PUBMED: 24833100
Notes: Cited By (since 1996):1 -- Export Date: 2 September 2014 -- CODEN: ASONF -- Source: Scopus
Altmetric Score
MSK Authors
  1. Mary Sue Brady
    165 Brady
  2. Charlotte Eielson Ariyan
    78 Ariyan
  3. Daniel Coit
    421 Coit
  4. Deborah Kuk
    81 Kuk
  5. Zubin Mickey Bamboat
    33 Bamboat