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[Sentinel node biopsy and lymph node dissection in the era of new systemic therapies for malignant melanoma]
1Universitätshautklinik, Eberhard-Karls Universität Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland. anja.ulmer@med.uni-tuebingen.de.
Background:
Recently, adjuvant therapies with checkpoint inhibitors and BRAF/MEK inhibitors have become available for patients with malignant melanoma and microscopic nodal disease. Meanwhile the number of complete nodal dissections for a melanoma-positive sentinel node (SN) have decreased significantly.
Objective:
The authors discuss the significance of sentinel node biopsy (SNB) and early lymph node dissection in the era of adjuvant systemic therapy for stage III melanoma.
Materials And Methods:
Current publications and recommendations were evaluated.
Results:
Complete nodal dissection for a positive SN significantly reduces the risk of regional nodal relapse. However, neither SNB nor complete nodal dissection following a positive SN are associated with a benefit in survival. With the availability of novel adjuvant systemic treatment strategies for stage III melanoma, SNB has become an even more important part of modern staging diagnostics. Thus, detection of early dissemination of melanoma cells into the SN as well as the quantification of the tumor load are decisive for further therapy planning.
Conclusion:
Accurate assessment of the regional lymph node status by SNB is becoming even more important in the era of novel effective adjuvant therapies for microscopic nodal disease. Whether complete lymph node dissection is performed in patients with a positive SN needs to be assessed individually. In the case of "active nodal surveillance" instead of surgery, long-term close follow-up in specialized centers, including ultrasonographic controls, is required.
Insights
Sentinel lymph node biopsy (SNB) is crucial for staging stage III melanoma patients receiving adjuvant therapies. While SNB and nodal dissection aid in risk assessment, survival benefits are not yet proven, necessitating individualized treatment decisions.
Area of Science:
- Oncology
- Dermatology
- Surgical Pathology
Background:
- Adjuvant therapies including checkpoint inhibitors and BRAF/MEK inhibitors are now available for melanoma with microscopic nodal disease.
- The utilization of complete nodal dissections for melanoma-positive sentinel nodes (SN) has notably decreased.
Purpose of the Study:
- To discuss the significance of sentinel node biopsy (SNB) and early lymph node dissection.
- To evaluate their role in the context of adjuvant systemic therapy for stage III melanoma.
Main Methods:
- A review of current publications and relevant clinical recommendations was conducted.
Main Results:
- Complete nodal dissection after a positive SN reduces regional nodal relapse risk.
- Neither SNB nor complete nodal dissection post-positive SN demonstrates a survival benefit.
- SNB is vital for staging in stage III melanoma, guiding therapy planning through early detection and tumor load quantification.
Conclusions:
- Accurate SNB for regional lymph node status is increasingly important with novel adjuvant therapies for microscopic nodal disease.
- The decision for complete lymph node dissection post-positive SN requires individual assessment.
- Active nodal surveillance necessitates long-term follow-up in specialized centers, including ultrasonography.
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