Conservative lymph node surgery for patients with stage III melanoma: a prospective longitudinal cohort

Therapeutic lymph node dissection has shown no clear benefits in terms of overall survival. However, appropriate regional control has repeatedly been reported in patients with lymph node metastasis.

The objective of the study was to analyze the outcomes of a conservative surgical approach to patients with melanoma and lymph node metastasis detected either clinically or by imaging tests.

A multicenter, prospective, longitudinal, single-arm cohort was conducted to recruit patients with melanoma who had 1-3 non-matted regional lymph node metastases (N1b, N2b) and were treated with conservative nodal surgery (conservative NS). The surgical procedure entailed resection of the metastatic lymph nodes identified, while preserving uninvolved lymph nodes in the regional basin. The patients received postoperative adjuvant immunotherapy according to routine clinical recommendations. The primary end-point was the 2-year regional lymph node recurrence-free survival (RRFS).

A total of 25 patients with lymph node metastasis underwent conservative NS to remove inguinal (44.00%) and axillary (56.00%) lymph node metastasis. During the follow-up, 36.00% (n = 9) of the patients developed recurrence in the regional basin treated with conservative NS. The 2-year RRFS was 65.70% (95% CI 46.30%-85.10%), and MSS was 78.10% (95% CI 60.85%-95.35%) at 2 years. Stage IIIB patients exhibited no statistically significant improvement in 2-year RRFS (83.30%) (log-rank P = .238). The short-term surgical complications reported were seroma (32%, n = 8), hematoma (8%, n = 2), and wound infection (4%, n = 1). No cases of lymphedema were observed.

Conservative NS has the potential to prevent unnecessary complete lymph node dissections, particularly in clinical settings where neoadjuvant immunotherapy is not a suitable first-line therapeutic option.