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01-11-2021 | Ultrasound | Melanoma

Surveillance of Sentinel Node-Positive Melanoma Patients Who Receive Adjuvant Therapy Without Undergoing Completion Lymph Node Dissection

Authors: Kristy K. Broman, MD, MPH, Deepti Bettampadi, MD, PhD, MPH, Jaileene Pérez-Morales, PhD, James Sun, MD, Dennis Kirichenko, MS, Michael J. Carr, MD, MS, Zeynep Eroglu, MD, Ahmad A. Tarhini, MD, PhD, Nikhil Khushalani, MD, Matthew B. Schabath, PhD, Amod Sarnaik, MD, Vernon K. Sondak, MD, Jonathan S. Zager, MD

Published in: Annals of Surgical Oncology | Issue 12/2021

Abstract

Introduction

Adjuvant therapy trials required completion lymph node dissection (CLND) for sentinel lymph node (SLN)-positive melanoma prior to systemic treatment, but nodal surveillance without CLND is now common. For patients receiving adjuvant therapy without CLND, patterns of recurrence are unknown and the value of regional nodal ultrasound alongside cross-sectional imaging is not well-defined.

Methods

In a retrospective cohort of SLN-positive melanoma patients managed with nodal surveillance from June 2014 to June 2019, we evaluated the association between adjuvant treatment and location of first recurrence (locoregional, nodal, distant, or multisite) using Chi-square tests. We compared methods of recurrence detection and cost by surveillance intensity using Chi-square and Dunn’s tests.

Results

Among 177 nodal surveillance patients, 66 (37%) received adjuvant therapy. Median follow-up was 24 months, during which 48 patients (27%) recurred. Adjuvant treatment did not alter patterns of initial recurrence (p = 0.76). Adjuvant therapy recipients more often had both nodal ultrasound and cross-sectional imaging surveillance (p < 0.01). Among 13 isolated nodal recurrences, 85% were within the first year and 85% were detected by examination and/or ultrasound. Increasing surveillance intensity was not associated with recurrence detection rates but increased overall cost and cost per detected recurrence.

Conclusion

Regardless of adjuvant treatment, most nodal recurrences occurred in the first year and were initially detected clinically or by ultrasound. Findings support continued use of examination and nodal basin ultrasound in addition to any planned cross-sectional imaging surveillance.

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Title: Surveillance of Sentinel Node-Positive Melanoma Patients Who Receive Adjuvant Therapy Without Undergoing Completion Lymph Node Dissection
Authors: Kristy K. Broman, MD, MPH
Deepti Bettampadi, MD, PhD, MPH
Jaileene Pérez-Morales, PhD
James Sun, MD
Dennis Kirichenko, MS
Michael J. Carr, MD, MS
Zeynep Eroglu, MD
Ahmad A. Tarhini, MD, PhD
Nikhil Khushalani, MD
Matthew B. Schabath, PhD
Amod Sarnaik, MD
Vernon K. Sondak, MD
Jonathan S. Zager, MD
Publication date: 01-11-2021
Publisher: Springer International Publishing
Keywords: Ultrasound
Computed Tomography
Melanoma
Melanoma
Computed Tomography
Ultrasound
Positron Emission Tomography
Published in: Annals of Surgical Oncology / Issue 12/2021
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-021-10570-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Surveillance of Sentinel Node-Positive Melanoma Patients Who Receive Adjuvant Therapy Without Undergoing Completion Lymph Node Dissection

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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