Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 4/2019

01-04-2019 | Melanoma

The Role of Completion Lymph Node Dissection for Sentinel Lymph Node-Positive Melanoma

Authors: Tina J. Hieken, MD, John M. Kane III, MD, Sandra L. Wong, MD

Published in: Annals of Surgical Oncology | Issue 4/2019

Login to get access

Abstract

Purpose and Methods

Completion lymph node dissection (CLND) for sentinel lymph node (SLN)-positive melanoma patients has been guideline-concordant standard of care since adoption of lymphatic mapping and SLN biopsy for the management of clinically node-negative melanoma patients more than 20 years ago. However, a trend for omission of CLND has been observed over the past decade, and we now have randomized, controlled clinical trial data to help guide treatment recommendations. Publication of these data prompted an American Society of Clinical Oncology—Society of Surgical Oncology 2018 clinical practice guideline update for these patients.

Results and Conclusions

Systematic review of current evidence supports a selective, individualized approach to CLND for SLN-positive melanoma. For low-risk, low-volume micrometastatic disease, SLN biopsy may be both diagnostic and therapeutic, and close clinical follow-up with imaging or CLND are reasonable options for appropriately selected patients. For higher-risk patients, omission of CLND requires careful consideration of risks versus benefits, relevant histopathology, and individualized patient discussion. This should address patient comorbidities and life expectancy, the predicted likelihood of additional positive nodes, availability of imaging surveillance, likelihood of adherence to imaging and clinical follow-up, consequences of regional recurrence, and the prognostic value of complete nodal staging and its impact on adjuvant therapy recommendations or clinical trial participation. Data on long-term outcomes, cost, and patient-reported quality of life measures are not yet available.
Literature
1.
Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127(4):392–9.CrossRefPubMed
2.
Garbe C, Peris K, Hauschild A, et al. Diagnosis and treatment of melanoma. European consensus-based interdisciplinary guideline–Update 2012. Eur J Cancer. 2012;48(15):2375–90.CrossRefPubMed
3.
Morton DL, Thompson JF, Cochran AJ, et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med. 2014;370(7):599–609.CrossRefPubMedPubMedCentral
4.
5.
Lee DY, Lau BJ, Huynh KT, et al. Impact of completion lymph node dissection on patients with positive sentinel lymph node biopsy in melanoma. J Am Coll Surg. 2016;223(1):9–18.CrossRefPubMedPubMedCentral
6.
Erickson Foster J, Velasco JM, Hieken TJ. Adverse outcomes associated with noncompliance with melanoma treatment guidelines. Ann Surg Oncol. 2008;15(9):2395–402.CrossRefPubMed
7.
Schuitevoerder D, Bubic I, Fortino J, Massimino KP, Vetto JT. Patients with sentinel lymph node positive melanoma: who needs completion lymph node dissection? Am J Surg. 2018;215(5):868–72.CrossRefPubMed
8.
Cormier JN, Xing Y, Ding M, et al. Population-based assessment of surgical treatment trends for patients with melanoma in the era of sentinel lymph node biopsy. J Clin Oncol. 2005;23(25):6054–62.CrossRefPubMed
9.
Bilimoria KY, Balch CM, Bentrem DJ, et al. Complete lymph node dissection for sentinel node-positive melanoma: assessment of practice patterns in the United States. Ann Surg Oncol. 2008;15(6):1566–76.CrossRefPubMed
10.
Chu BS, Koffi W, Hoehn RS, et al. Improvement and persistent disparities in completion lymph node dissection: lessons from the National Cancer Database. J Surg Oncol. 2017;116(8):1176–84.CrossRefPubMedPubMedCentral
11.
Gershenwald JE, Andtbacka RH, Prieto VG, et al. Microscopic tumor burden in sentinel lymph nodes predicts synchronous nonsentinel lymph node involvement in patients with melanoma. J Clin Oncol. 2008;26(26):4296–303.CrossRefPubMedPubMedCentral
12.
Pasquali S, Mocellin S, Mozzillo N, et al. Nonsentinel lymph node status in patients with cutaneous melanoma: results from a multi-institution prognostic study. J Clin Oncol. 2014;32(9):935–41.CrossRefPubMed
13.
Leiter U, Stadler R, Mauch C, et al. Complete lymph node dissection versus no dissection in patients with sentinel lymph node biopsy positive melanoma (DeCOG-SLT): a multicentre, randomised, phase 3 trial. Lancet Oncol. 2016;17(6):757–67.CrossRefPubMed
14.
Faries MB, Thompson JF, Cochran AJ, et al. Completion dissection or observation for sentinel-node metastasis in melanoma. N Engl J Med. 2017;376(23):2211–22.CrossRefPubMedPubMedCentral
15.
Wong SL, Faries MB, Kennedy EB, et al. Sentinel lymph node biopsy and management of regional lymph nodes in melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Clinical Practice Guideline Update. Ann Surg Oncol 2018;25(2):356–77.CrossRefPubMed
16.
American College of Surgeons Clinical Research Program, MHG Katz (eds). Operative standards for cancer surgery. Volume II: esophagus, melanoma, rectum, stomach, thyroid. Wolters Kluwer; 2018.
17.
Cascinelli N, Morabito A, Santinami M, MacKie RM, Belli F. Immediate or delayed dissection of regional nodes in patients with melanoma of the trunk: a randomised trial. WHO Melanoma Programme. Lancet 1998;351(9105):793–6.PubMed
18.
Morton DL, Thompson JF, Cochran AJ, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355(13):1307–17.CrossRefPubMed
19.
Callender GG, McMasters KM. Early versus delayed complete lymphadenectomy in melanoma: insight from MSLT I. Ann Surg Oncol. 2011;18(2):306–8.CrossRefPubMed
20.
Pasquali S, Sommariva A, Spillane AJ, Bilimoria KY, Rossi CR. Measuring the quality of melanoma surgery—highlighting issues with standardization and quality assurance of care in surgical oncology. Eur J Surg Oncol. 2017;43(3):561–71.CrossRefPubMed
21.
Minami CA, Wayne JD, Yang AD, et al. National evaluation of hospital performance on the new commission on cancer melanoma quality measures. Ann Surg Oncol. 2016;23(11):3548–57.CrossRefPubMed
22.
Grotz TE, Huebner M, Pockaj BA, Perkins S, Jakub JW. Limitations of lymph node ratio, evidence-based benchmarks, and the importance of a thorough lymph node dissection in melanoma. Ann Surg Oncol. 2013;20(13):4370–7.CrossRefPubMed
23.
Balch CM, Soong SJ, Gershenwald JE, et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol. 2001;19(16):3622–34.CrossRefPubMed
24.
Chakera AH, Hesse B, Burak Z, et al. EANM-EORTC general recommendations for sentinel node diagnostics in melanoma. Eur J Nucl Med Mol Imaging. 2009;36(10):1713–42.CrossRefPubMed
25.
26.
Valsecchi ME, Silbermins D, de Rosa N, Wong SL, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in patients with melanoma: a meta-analysis. J Clin Oncol. 2011;29(11):1479–87.CrossRefPubMed
27.
Ghaferi AA, Wong SL, Johnson TM, et al. Prognostic significance of a positive nonsentinel lymph node in cutaneous melanoma. Ann Surg Oncol. 2009;16(11):2978–84.CrossRefPubMed
28.
Ariyan C, Brady MS, Gonen M, Busam K, Coit D. Positive nonsentinel node status predicts mortality in patients with cutaneous melanoma. Ann Surg Oncol. 2009;16(1):186–90.CrossRefPubMed
29.
Brown RE, Ross MI, Edwards MJ, et al. The prognostic significance of nonsentinel lymph node metastasis in melanoma. Ann Surg Oncol. 2010;17(12):3330–5.CrossRefPubMed
30.
Leung AM, Morton DL, Ozao-Choy J, et al. Staging of regional lymph nodes in melanoma: a case for including nonsentinel lymph node positivity in the American Joint Committee on Cancer staging system. JAMA Surg. 2013;148(9):879–84.CrossRefPubMed
31.
Sabel MS, Griffith K, Sondak VK, et al. Predictors of nonsentinel lymph node positivity in patients with a positive sentinel node for melanoma. J Am Coll Surg. 2005;201(1):37–47.CrossRefPubMed
32.
Lee JH, Essner R, Torisu-Itakura H, Wanek L, Wang H, Morton DL. Factors predictive of tumor-positive nonsentinel lymph nodes after tumor-positive sentinel lymph node dissection for melanoma. J Clin Oncol. 2004;22(18):3677–84.CrossRefPubMed
33.
Murali R, Desilva C, Thompson JF, Scolyer RA. Non-Sentinel Node Risk Score (N-SNORE): a scoring system for accurately stratifying risk of non-sentinel node positivity in patients with cutaneous melanoma with positive sentinel lymph nodes. J Clin Oncol. 2010;28(29):4441–9.CrossRefPubMed
34.
Wevers KP, Murali R, Bastiaannet E, et al. Assessment of a new scoring system for predicting non-sentinel node positivity in sentinel node-positive melanoma patients. Eur J Surg Oncol. 2013;39(2):179–84.CrossRefPubMed
35.
Feldmann R, Fink AM, Jurecka W, Rappersberger K, Steiner A. Accuracy of the non-sentinel node risk score (N-SNORE) in patients with cutaneous melanoma and positive sentinel lymph nodes: a retrospective study. Eur J Surg Oncol 2014;40(1):73–6.CrossRefPubMed
36.
Wrightson WR, Wong SL, Edwards MJ, et al. Complications associated with sentinel lymph node biopsy for melanoma. Ann Surg Oncol 2003;10(6):676–80.CrossRefPubMed
37.
Theodore JE, Frankel AJ, Thomas JM, et al. Assessment of morbidity following regional nodal dissection in the axilla and groin for metastatic melanoma. ANZ J Surg 2017;87(1–2):44–8.CrossRefPubMed
38.
Henderson MA, Burmeister BH, Ainslie J, et al. Adjuvant lymph-node field radiotherapy versus observation only in patients with melanoma at high risk of further lymph-node field relapse after lymphadenectomy (ANZMTG 01.02/TROG 02.01): 6-year follow-up of a phase 3, randomised controlled trial. Lancet Oncol 2015;16(9):1049–60.CrossRefPubMed
39.
Sabel MS, Griffith KA, Arora A, et al. Inguinal node dissection for melanoma in the era of sentinel lymph node biopsy. Surgery. 2007;141(6):728–35.CrossRefPubMed
40.
Faries MB, Thompson JF, Cochran A, et al. The impact on morbidity and length of stay of early versus delayed complete lymphadenectomy in melanoma: results of the Multicenter Selective Lymphadenectomy Trial (I). Ann Surg Oncol. 2010;17(12):3324–9.CrossRefPubMedPubMedCentral
41.
Egger ME, Kimbrough CW, Stromberg AJ, et al. Melanoma patient-reported quality of life outcomes following sentinel lymph node biopsy, completion lymphadenectomy, and adjuvant interferon: results from the Sunbelt Melanoma Trial. Ann Surg Oncol. 2016;23(3):1019–25.CrossRefPubMed
42.
Eggermont AM, Chiarion-Sileni V, Grob JJ, et al. Prolonged survival in Stage III melanoma with ipilimumab adjuvant therapy. N Engl J Med. 2016;375(19):1845–55.CrossRefPubMedPubMedCentral
43.
Long GV, Hauschild A, Santinami M, et al. Adjuvant dabrafenib plus trametinib in stage III BRAF-mutated melanoma. N Engl J Med. 2017;377(19):1813–23.CrossRefPubMed
44.
Weber J, Mandala M, Del Vecchio M, et al. Adjuvant nivolumab versus ipilimumab in resected stage III or IV melanoma. N Engl J Med. 2017;377(19):1824–35.CrossRefPubMed
45.
Eggermont AMM, Blank CU, Mandala M, et al. Adjuvant pembrolizumab versus placebo in resected stage III melanoma. N Engl J Med. 2018;378(19):1789–801.CrossRefPubMed
46.
Meves A, Nikolova E, Heim JB, et al. Tumor cell adhesion as a risk factor for sentinel lymph node metastasis in primary cutaneous melanoma. J Clin Oncol. 2015;33(23):2509–15.CrossRefPubMedPubMedCentral
47.
48.
Egger ME, Xiao D, Hao H, et al. Unique genes in tumor-positive sentinel lymph nodes associated with nonsentinel lymph node metastases in melanoma. Ann Surg Oncol. 2018;25(5):1296–303.CrossRefPubMed
Metadata
Title
The Role of Completion Lymph Node Dissection for Sentinel Lymph Node-Positive Melanoma
Authors
Tina J. Hieken, MD
John M. Kane III, MD
Sandra L. Wong, MD
Publication date
01-04-2019
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 4/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-6812-z

Other articles of this Issue 4/2019

Annals of Surgical Oncology 4/2019 Go to the issue

Breast Oncology

The Impact of Radiotherapy on Reoperation Rates in Patients Undergoing Mastectomy and Breast Reconstruction

Health Services Research and Global Oncology

Psychosocial Risks are Independently Associated with Cancer Surgery Outcomes in Medically Comorbid Patients

Pancreatic Tumors

Splenic Preservation Just Might Be Reasonable for Patients with Left-Sided Pancreatic Cancer

Pancreatic Tumors

Endoscopic Retrograde Biliary Drainage Causes Intra-Abdominal Abscess in Pancreaticoduodenectomy Patients: An Important But Neglected Risk Factor

ASO Author Reflections

ASO Author Reflections: It is Essential to Explore More Accurate Nodal Staging System for Esophageal Cancer

Breast Oncology

Minimally Invasive Intact Excision of High-Risk Breast Lesions and Small Breast Cancers: The Intact Percutaneous Excision (IPEX) Registry