Is there still a place for lymph node dissection for stage III melanoma since the approval of adjuvant therapy

This review aims to explore the evolving management strategies for stage III melanoma, focusing on the comparative effectiveness of traditional surgical approaches like complete lymph node dissection (CLND) versus modern adjuvant therapies. It also examines the latest evidence on the efficacy, risks, and complications of these strategies, emphasizing the role of shared decision-making between patients and clinicians.

Recent clinical trials and meta-analyses, including the MSLT-II and DeCOG-SLT studies, have demonstrated that CLND may not significantly improve survival outcomes in melanoma patients with sentinel lymph node biopsy (SLNB)-positive status. Instead, a shift towards observation combined with adjuvant therapies such as immune checkpoint inhibitors and targeted therapies (for BRAF-mutant melanoma) has been observed. These approaches have been associated with similar or improved recurrence-free survival rates and reduced treatment-related complications. However, challenges remain in establishing standardized protocols for adjuvant therapy use.

The management of stage III melanoma is rapidly transitioning from routine CLND towards a more individualized approach that incorporates active surveillance and adjuvant therapies based on tumor biology and patient-specific factors. Multidisciplinary discussions are essential to guide treatment decisions, and further research is required to develop clear, evidence-based protocols.