Is Ultrasound-Based Imaging Essential for Melanoma Active Surveillance?

Area of Science:

• Melanoma research
• Oncology
• Medical imaging

Background:

• Landmark trials support active surveillance with nodal ultrasound (US) for sentinel lymph node (SLN)-positive melanoma, offering outcomes equivalent to completion lymph node dissection (CLND).
• Real-world adherence to US surveillance is inconsistent.
• The role of US alongside modern cross-sectional imaging requires definition.

Purpose of the Study:

• To assess adherence to guideline-concordant surveillance in SLN-positive melanoma patients.
• To evaluate recurrence detection patterns and the diagnostic yield of biopsies.
• To identify predictors of surveillance adherence.

Main Methods:

• Retrospective cohort study of 240 SLN-positive adult melanoma patients (2017-2023).
• Assessed surveillance adherence for 2 years post-resection.
• Used multivariable logistic regression to identify predictors of adherence.

Main Results:

• 92.9% of patients were planned for active surveillance; 55.3% adhered to US, while 88.0% underwent cross-sectional imaging.
• Cross-sectional imaging detected 64.9% of recurrences, significantly more than US (7.8%).
• Later diagnosis predicted US adherence; older age and head/neck tumors predicted lower adherence.

Conclusions:

• Cross-sectional imaging demonstrated superior performance and consistency compared to nodal basin US.
• Findings suggest modernizing melanoma surveillance programs to minimize excessive testing.
• Re-evaluation of strict adherence to MSLT-II trial protocols in current practice is warranted.