Completion Lymphadenectomy for Melanoma Patients With a Positive Sentinel Node Biopsy Remains Standard of Care

Excerpt

In many parts of the world, sentinel node biopsy (SNB) for high-risk primary cutaneous melanoma (≥1 mm in thickness) is now considered reasonable care, particularly since the initial results of the Multicenter Selective Lymphadenectomy Trial (MSLT) were presented.1 This study set out to resolve the issue of whether SNB could reliably and accurately identify the 20% of melanoma patients with occult regional lymph node metastases who might benefit from a completion lymph node dissection (CLND). In summary, no survival difference was found between patients randomized to SNB (with completion lymphadenectomy if positive) and those randomized to standard care with observation and lymphadenectomy if a regional recurrence occurred. However, and particularly germane to the study presented by Wong et al.2 in this issue of the Journal, patients with a positive SNB who underwent an immediate CLND had significantly superior survival compared with patients randomized to the control arm who underwent lymphadenectomy after symptomatic presentation (5-year survival rates were 71% vs. 55%; P = .0033). The implications of this observation are clear; resection of low-volume micrometastatic disease early in the course of the disease is superior to resection of symptomatic later-stage higher-volume disease. …