Use of Completion Lymph Node Dissection for Sentinel Lymph Node-Positive Melanoma.

Area of Science:

• Oncology
• Surgical Oncology
• Melanoma Research

Background:

• Randomized trials since 2015 indicate no survival benefit for routine completion lymph node dissection (CLND) in selected patients with sentinel node-positive melanoma (SNPM).
• This study investigates temporal trends and influencing factors of CLND utilization in SNPM patients.

Purpose of the Study:

• To analyze time trends in the application of CLND for SNPM.
• To identify patient, pathologic, and institutional factors associated with CLND decision-making.

Main Methods:

• Utilized the National Cancer Database (2012-2016) for patients over 18 with SNPM.
• Employed Poisson regression to assess temporal trends and identify predictors of CLND.
• Defined high-volume centers based on sentinel node procedure frequency (>80th percentile).

Main Results:

• The proportion of SNPM patients undergoing CLND decreased from 61-63% (2012-2014) to 50% in 2016 (p < 0.0001).
• This decline occurred in both high- and lower-volume centers.
• Factors associated with lower CLND likelihood included female sex and older age; increased Breslow depth, ulceration, and high-volume centers were associated with higher likelihood.

Conclusions:

• CLND rates for SNPM have declined, particularly after 2015.
• Patient, pathologic, and institutional characteristics influence CLND utilization.
• Standardized patient selection for CLND is crucial, aligning with evidence supporting close observation for select cases.