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The Role of Completion Lymph Node Dissection for Sentinel Lymph Node-Positive Melanoma
Tina J Hieken1, John M Kane2, Sandra L Wong3
1Department of Surgery, Mayo Clinic, Rochester, MN, USA. hieken.tina@mayo.edu.
Annals of Surgical Oncology
|October 5, 2018
Summary
For melanoma patients with positive sentinel lymph node biopsy, completion lymph node dissection (CLND) should be individualized. Selective CLND is recommended for high-risk cases, while low-risk patients may benefit from close follow-up instead.
Area of Science:
- Oncology
- Surgical Oncology
- Dermatology
Background:
- Completion lymph node dissection (CLND) has been standard for sentinel lymph node (SLN)-positive melanoma patients for over 20 years.
- A recent trend shows omission of CLND, with new randomized trial data influencing guidelines.
Purpose of the Study:
- To review current evidence regarding CLND for SLN-positive melanoma.
- To guide treatment recommendations based on recent clinical trial data and updated guidelines.
Main Methods:
- Systematic review of current evidence.
- Analysis of randomized, controlled clinical trial data.
- Consideration of the 2018 American Society of Clinical Oncology-Society of Surgical Oncology guideline update.
Main Results:
- Current evidence supports a selective, individualized approach to CLND for SLN-positive melanoma.
- For low-risk, low-volume micrometastatic disease, SLN biopsy alone may suffice, with close follow-up as an option.
- Omission of CLND in higher-risk patients requires careful risk-benefit analysis and patient discussion.
Conclusions:
- An individualized approach to CLND for SLN-positive melanoma is supported by evidence.
- Patient factors, disease characteristics, and follow-up capabilities should guide CLND decisions.
- Further data on long-term outcomes, cost, and quality of life are needed.
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