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An evidence-based approach to positive sentinel node disease: should we ever do a completion node dissection?

Jennifer S Downs1, David E Gyorki1,2,3

  • 1Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, 3000, Australia.

Melanoma Management
|December 7, 2019
PubMed
Summary

Management of advanced melanoma has changed. Sentinel lymph node biopsy is standard, but new trials show completion lymphadenectomy offers no survival benefit for positive nodes, altering practice guidelines.

Keywords:
DeCOG-SLTMSLT-2lymph nodelymphadenectomymelanomasentinel node

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Dermatology

Background:

  • Sentinel node biopsy is a standard staging method for melanoma.
  • Recent clinical trials have investigated the role of completion lymphadenectomy after positive sentinel node biopsy.

Purpose of the Study:

  • To evaluate the impact of completion lymphadenectomy on survival outcomes in melanoma patients with positive sentinel node biopsies.
  • To inform current international practice guidelines for melanoma management.

Main Methods:

  • Analysis of data from two recent randomized-controlled trials.
  • Comparison of survival rates between patients who underwent completion lymphadenectomy and those who did not.

Main Results:

  • No significant survival advantage was demonstrated for patients undergoing completion lymphadenectomy following a positive sentinel node biopsy.
  • These findings challenge the routine use of completion lymphadenectomy in the majority of melanoma cases.

Conclusions:

  • Current evidence does not support completion lymphadenectomy for most patients with positive sentinel node biopsies in melanoma.
  • International practice guidelines are evolving to reflect the lack of survival benefit from this additional surgical procedure.