Sentinel lymph node biopsy followed by lymph node dissection for localised primary cutaneous melanoma

Area of Science:

• Oncology
• Dermatology
• Surgical Oncology

Background:

• Melanoma, the deadliest skin cancer, is primarily treated with surgery, including wide excision and sentinel lymph node biopsy (SLNB) for staging.
• SLNB is crucial for accurate staging of localized primary cutaneous melanoma, guiding subsequent treatment decisions.

Purpose of the Study:

• To evaluate the efficacy and safety of sentinel lymph node biopsy (SLNB) followed by completion lymph node dissection (CLND) for localized primary cutaneous melanoma.

Main Methods:

• A systematic review of randomized controlled trials (RCTs) was conducted, searching multiple databases up to February 2015.
• Two independent reviewers assessed trial eligibility, extracted data on survival and recurrence, and analyzed treatment complications.
• Primary outcomes included overall survival and treatment complication rates; secondary outcomes encompassed disease-specific survival, disease-free survival, local recurrence, and distant metastases.

Main Results:

• A single trial with 2001 participants was included, comparing SLNB with observation.
• SLNB showed no significant difference in disease-specific survival for intermediate-thickness or thick melanomas but favored observation regarding nodal basin complications.
• Disease-free survival and reduced local/regional recurrence favored SLNB, while distant metastases rates were higher with SLNB.

Conclusions:

• While SLNB may improve disease-free survival and reduce local recurrence, it is associated with increased nodal basin morbidity.
• The current evidence for SLNB's effectiveness in localized primary cutaneous melanoma is of low quality, with insufficient data on overall survival.
• Further research is needed to definitively establish the benefits of SLNB compared to observation in melanoma management.