ASO Author Reflections: Optimizing the Outcomes for Patients: The Evolution of the Management of Regional Disease in Patients with Melanoma

Excerpt

Evolution in the management of the lymph node basin over the past two decades has been remarkable. That transformation is largely attributable to the work of Dr. Donald Morton, whose landmark Multicenter Selective Lymphadenectomy Trial (MSLT)-11 and MSLT-22 were designed to address the role that surgery should play in patients with microscopic regional disease. MSLT-1 demonstrated that sentinel lymph node biopsy (SLNB) accurately identifies nodal metastatic disease, confirmed the obsolete role of elective lymphadenectomy, and demonstrated a survival benefit to early intervention in the subset of patients harboring regional metastases. Since this trial, the utilization of SLNB has significantly reduced the number of patients undergoing lymphadenectomy for bulky disease, which is associated with higher morbidity.3 MSLT-2 demonstrated that most patients achieved complete regional control with SLNB alone, and provided support that completion lymphadenectomy (CLND) does not impact overall survival. Taken together, these studies argue for a reduction in the extent of surgery needed to achieve regional control, which reduces surgical morbidity. …