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Does Stage Migration Occur as a Consequence of Omitting Completion Lymph Node Dissection for Melanoma?
Zachary J Senders1, Edmund K Bartlett2, Tyler J Mouw3
1Division of Surgical Oncology, Hiram C. Polk, Jr, MD Department of Surgery, University of Louisville, Louisville, KY, USA. zachary.senders@louisville.edu.
Annals of Surgical Oncology
|March 19, 2023
Summary
Completion lymph node dissection (CLND) use decreased significantly, but melanoma staging and adjuvant therapy decisions were not meaningfully impacted. This study analyzed stage migration in patients with cutaneous melanoma.
Area of Science:
- Oncology
- Surgical Oncology
- Dermatology
Background:
- Completion lymph node dissection (CLND) is no longer routinely recommended for melanoma treatment.
- Omission of CLND may lead to understaging, potentially affecting adjuvant therapy recommendations.
- The study investigates stage migration due to declining CLND use.
Purpose of the Study:
- To determine if stage migration has occurred in melanoma patients with the declining use of CLND.
- To assess the impact of CLND omission on accurate cancer staging.
Main Methods:
- Analysis of the National Cancer Database (NCDB) from 2012-2018 for patients with clinically node-negative melanoma (≥T1b).
- Comparison of outcomes between patients undergoing sentinel lymph node biopsy (SLNB) alone versus SLNB + CLND.
- Evaluation of CLND utilization rates and changes in AJCC staging.
Main Results:
- CLND utilization decreased from 59% in 2012 to 12.6% in 2018.
- Patients undergoing CLND were younger and more likely male.
- Despite decreased CLND use, the incidence of stage IIIA melanoma remained stable, with no clinically significant stage migration observed.
Conclusions:
- The dramatic decline in CLND utilization has not led to clinically meaningful stage migration.
- Accurate staging for adjuvant therapy decisions in melanoma appears unaffected by reduced CLND rates.
