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01-09-2014 | Melanomas

Observation After a Positive Sentinel Lymph Node Biopsy in Patients with Melanoma

Authors: Zubin M. Bamboat, MD, Ioannis T. Konstantinidis, MD, Deborah Kuk, ScM, Charlotte E. Ariyan, MD, PhD, Mary Sue Brady, MD, Daniel G. Coit, MD

Published in: Annals of Surgical Oncology | Issue 9/2014

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).

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Title: Observation After a Positive Sentinel Lymph Node Biopsy in Patients with Melanoma
Authors: Zubin M. Bamboat, MD
Ioannis T. Konstantinidis, MD
Deborah Kuk, ScM
Charlotte E. Ariyan, MD, PhD
Mary Sue Brady, MD
Daniel G. Coit, MD
Publication date: 01-09-2014
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 9/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-014-3758-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Observation After a Positive Sentinel Lymph Node Biopsy in Patients with Melanoma

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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