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The Evolution of the Sentinel Node Biopsy in Melanoma
Alexandra Allard-Coutu1, Victoria Dobson2, Erika Schmitz1
1Department of General Surgery, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
Abstract:
The growing repertoire of approved immune-checkpoint inhibitors and targeted therapy has revolutionized the adjuvant treatment of melanoma. While the treatment of primary cutaneous melanoma remains wide local excision (WLE), the management of regional lymph nodes continues to evolve in light of practice-changing clinical trials and dramatically improved adjuvant therapy. With large multicenter studies reporting no benefit in overall survival for completion lymph node dissection (CLND) after a positive sentinel node biopsy (SLNB), controversy remains regarding patient selection and clinical decision-making. This review explores the evolution of the SLNB in cutaneous melanoma in the context of a rapidly changing adjuvant treatment landscape, summarizing the key clinical trials which shaped current practice guidelines.
Insights
Sentinel lymph node biopsy (SLNB) is evolving in melanoma care. Recent trials show completion lymph node dissection (CLND) offers no survival benefit, impacting clinical decisions for regional lymph node management.
Area of Science:
- Oncology
- Dermatology
- Surgical Oncology
Background:
- Adjuvant therapy for melanoma has been revolutionized by immune-checkpoint inhibitors and targeted therapies.
- Management of regional lymph nodes in cutaneous melanoma is evolving due to new clinical trials and improved adjuvant treatments.
Purpose of the Study:
- To review the evolution of sentinel lymph node biopsy (SLNB) in cutaneous melanoma.
- To summarize key clinical trials influencing current practice guidelines for lymph node management in melanoma.
Main Methods:
- Literature review of practice-changing clinical trials.
- Analysis of the impact of adjuvant therapy on regional lymph node management.
Main Results:
- Wide local excision (WLE) remains standard for primary cutaneous melanoma.
- Large multicenter studies indicate no overall survival benefit from completion lymph node dissection (CLND) after a positive SLNB.
Conclusions:
- Controversy persists regarding patient selection and clinical decision-making for CLND after positive SLNB.
- The changing adjuvant treatment landscape necessitates a re-evaluation of SLNB's role and subsequent management strategies.
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