Management of the positive sentinel lymph node in the post‐MSLT‐II era

• Published in: Journal of surgical oncology Vol. 122; no. 8; pp. 1778 - 1784
• Main Authors: Bredbeck, Brooke C., Mubarak, Eman, Zubieta, Daniela G., Tesorero, Rachael, Holmes, Adam R., Dossett, Lesly A., VanKoevering, Kyle K., Durham, Alison B., Hughes, Tasha M.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.12.2020
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; CLND; Databases, Factual; Female; Follow-Up Studies; Humans; Lymph Node Excision - methods; Lymphatic system; Male; Melanoma; Melanoma - pathology; Melanoma - surgery; Middle Aged; MSLT‐II; Prognosis; Prospective Studies; Sentinel Lymph Node - pathology; Sentinel Lymph Node - surgery; Sentinel Lymph Node Biopsy; Skin Neoplasms - pathology; Skin Neoplasms - surgery; SLNB; Surveillance; Tumor Burden; Young Adult; CLND; MSLT-II; melanoma; SLNB
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.26200

Background and Objectives The publication of MSLT‐II shifted recommendations for management of sentinel lymph node biopsy positive (SLNB+) melanoma to favor active surveillance. We examined trends in immediate completion lymph node dissection (CLND) following publication of MSLT‐II. Methods Using a prospective melanoma database at a high‐volume center, we identified a cohort of consecutive SLNB+ patients from July 2016 to April 2019. Patient and disease characteristics were analyzed with multivariate logistic regression to examine factors associated with CLND. Results Two hundred and thirty‐five patients were included for analysis. CLND rates were 67%, 33%, and 26% for the year before, year after, and second‐year following MSLT‐II. Factors associated with undergoing CLND included primary located in the head and neck (59% vs 33%, P = .003 and odds ratio [OR], 5.22, P = .002) and higher sentinel node tumor burden (43% vs 10% for tumor burden ≥0.1 mm, P < .001 and OR, 8.64, P = .002). Conclusions Rates of CLND in SLNB+ melanoma decreased dramatically, albeit not uniformly, following MSLT‐II. Factors that increased the likelihood of immediate CLND were primary tumor located in the head and neck and high sentinel node tumor burden. These groups were underrepresented in MSLT‐II, suggesting that clinicians are wary of implementing active surveillance recommendations for patients perceived as higher risk.