[Sentinel node-positive melanoma].

Area of Science:

• Oncology
• Dermatology
• Surgical Oncology

Background:

• Melanoma metastasis to the sentinel node (SN) traditionally prompted complete lymph node dissection (CLND).
• Complete lymph node dissection (CLND) is associated with significant patient morbidity.
• Recent randomized studies have questioned the necessity of immediate CLND for SN-positive melanoma patients.

Purpose of the Study:

• To evaluate survival outcomes in melanoma patients with sentinel node metastasis.
• To compare immediate complete lymph node dissection (CLND) versus surveillance with ultrasound.
• To inform updated clinical guidelines regarding the management of SN-positive melanoma.

Main Methods:

• Analysis of two recent randomized studies comparing immediate CLND versus surveillance.
• Surveillance protocol involved close ultrasound monitoring of SN-positive regions.
• CLND was reserved for patients developing further metastases during follow-up.

Main Results:

• No significant difference in survival was observed between patients undergoing immediate CLND and those managed with surveillance.
• Ultrasound-guided surveillance proved effective in detecting subsequent metastases.
• The findings support a shift away from routine, high-morbidity CLND.

Conclusions:

• Routine complete lymph node dissection (CLND) for melanoma patients with sentinel node (SN) metastasis is not superior to surveillance.
• Ultrasound-guided surveillance offers a less morbid alternative for managing SN-positive melanoma patients.
• Danish guidelines now reflect this evidence, recommending surveillance over immediate CLND for SN-positive cases.