Outcome of patients with a positive sentinel lymph node who do not undergo completion lymphadenectomy

Completion lymph node dissection (CLND), although considered a standard approach for patients with melanoma and a positive sentinel lymph node (SLN), is not performed in as many as 50% of indicated cases. This study evaluates the outcome of patients who had a positive SLN but did not undergo CLND at Memorial Sloan-Kettering Cancer Center.

A prospective database was used to identify all patients with a positive SLN from 1992 to 2008. Patient and tumor characteristics, number of positive SLNs, recurrence pattern, reason for not performing a CLND, and current status were evaluated.

There were 2269 patients who underwent SLN biopsy. Three hundred thirteen had a positive SLN, of whom 271 (87%) had a CLND and 42 (13%) did not. Patients in the no-CLND group were older (median age 70 vs. 56 years, P < .01), and had a trend toward thicker melanomas (3.5 vs. 2.8 mm, P < .06). A significantly higher percentage of no- CLND patients had lower-extremity melanomas (40% vs. 13% CLND; P < .01). The most common reason for not performing a CLND was patient refusal (45%). There were similar rates and patterns of recurrence between the two groups. Recurrence-free survival and disease-specific survival were also similar between the groups.

It remains unclear whether CLND must be performed in all melanoma patients with a positive SLN. For selected informed patients who choose not to participate in the Multicenter Selective Lymphadenectomy Trial II trial, or in centers where the trial is not available, nodal observation may be an acceptable option.