Regional lymphadenectomy

The Multicenter Selective Lymphadenectomy Trial II (MSLT-II [NCT00297895]) included 1,934 patients with primary melanomas and a positive sentinel node(s). Patients were randomly assigned to undergo either completion lymphadenectomy (n = 967) or nodal observation with ultrasound (n = 967). The primary end point was melanoma-specific survival.[15][Level of evidence A1]

The Multicenter Selective Lymphadenectomy Trial II (MSLT-II [NCT00297895]) included 1,934 patients with primary melanomas and a positive sentinel node(s). Patients were randomly assigned to undergo either completion lymphadenectomy (n = 967) or nodal observation with ultrasound (n = 967). The primary end point was melanoma-specific survival.[15][Level of evidence A1]

After a follow-up of 3 years, there was no melanoma-specific survival advantage for patients randomly assigned to undergo completion lymphadenectomy versus nodal observation with ultrasound and delayed lymphadenectomy for subsequent nodal recurrence (86% [±1.3%] vs. 86% [±1.2%]; HR, 1.08; 95% CI, 0.88–1.34; P = .42).

The Multicenter Selective Lymphadenectomy Trial II (MSLT-II [NCT00297895]) included 1,934 patients with primary melanomas and a positive sentinel node(s). Patients were randomly assigned to undergo either completion lymphadenectomy (n = 967) or nodal observation with ultrasound (n = 967). The primary end point was melanoma-specific survival.[15][Level of evidence A1]

At 3 years, the rate of nodal recurrence was 69% lower in the dissection group than in the observation group, with regional nodal disease control rates of 92% (±1.0%) versus 77% (±1.5%), respectively (HR, 0.31; 95% CI, 0.24–0.41; P < .001).

The Multicenter Selective Lymphadenectomy Trial II (MSLT-II [NCT00297895]) included 1,934 patients with primary melanomas and a positive sentinel node(s). Patients were randomly assigned to undergo either completion lymphadenectomy (n = 967) or nodal observation with ultrasound (n = 967). The primary end point was melanoma-specific survival.[15][Level of evidence A1]

With a median follow-up of 43 months, there was no significant difference in distant metastasis–free survival (DMFS) between the two groups (HR, 1.10; 95% CI, 0.92–1.31; P = .31).

The Multicenter Selective Lymphadenectomy Trial II (MSLT-II [NCT00297895]) included 1,934 patients with primary melanomas and a positive sentinel node(s). Patients were randomly assigned to undergo either completion lymphadenectomy (n = 967) or nodal observation with ultrasound (n = 967). The primary end point was melanoma-specific survival.[15][Level of evidence A1]

Adverse events were more common among the surgical cohort. Specifically, lymphedema occurred in 24.1% of patients in the dissection group versus 6.3% of patients in the observation group (P < .0001).

The Multicenter Selective Lymphadenectomy Trial II (MSLT-II [NCT00297895]) included 1,934 patients with primary melanomas and a positive sentinel node(s). Patients were randomly assigned to undergo either completion lymphadenectomy (n = 967) or nodal observation with ultrasound (n = 967). The primary end point was melanoma-specific survival.[15][Level of evidence A1]

A subgroup analysis did not identify any group (i.e., patients with >1 positive sentinel lymph node or a sentinel lymph node tumor diameter >1 mm) that would benefit from a complete lymph node dissection.

The DeCOG-SLT trial (NCT02434107) included 483 patients with primary melanoma and microscopically detected nodal metastases. Patients were randomly assigned to undergo completion lymphadenectomy (n = 240) or observation (n = 233). The primary end point was DMFS.[16][Level of evidence B1]

The DeCOG-SLT trial (NCT02434107) included 483 patients with primary melanoma and microscopically detected nodal metastases. Patients were randomly assigned to undergo completion lymphadenectomy (n = 240) or observation (n = 233). The primary end point was DMFS.[16][Level of evidence B1]

At a median follow-up of 35.5 months, there was no difference in DMFS between patients randomly assigned to undergo observation (77%; 90% CI, 71.9%–82.1%) versus completion lymphadenectomy (74.9%; 90% CI, 69.5%–80.3%) (HR, 1.03; 90% CI, 0.71–1.50; P = .87).

The DeCOG-SLT trial (NCT02434107) included 483 patients with primary melanoma and microscopically detected nodal metastases. Patients were randomly assigned to undergo completion lymphadenectomy (n = 240) or observation (n = 233). The primary end point was DMFS.[16][Level of evidence B1]

At 3 years, the OS rates were similar between patients randomly assigned to undergo observation (81.7%; 90% CI, 76.8%–86.6%) versus completion lymphadenectomy (81.2%; 90% CI, 76.1%–86.3%) (HR, 0.96; 90% CI, 0.67–1.38; P = .87), although the trial was closed early due to low event rates.

The DeCOG-SLT trial (NCT02434107) included 483 patients with primary melanoma and microscopically detected nodal metastases. Patients were randomly assigned to undergo completion lymphadenectomy (n = 240) or observation (n = 233). The primary end point was DMFS.[16][Level of evidence B1]

In an exploratory analysis of DMFS in patients with micrometastasis thicker than 1 mm, there was no difference between the treatment groups (HR, 1.03; 90% CI, 0.63–1.71).