Lymph node management

The International Multicenter Selective Lymphadenectomy Trial (MSLT-1) included 1,269 patients with intermediate-thickness (defined as 1.2–3.5 mm in this study) primary melanomas. The primary end point was melanoma-specific survival.[15][Level of evidence A1]

The International Multicenter Selective Lymphadenectomy Trial (MSLT-1) included 1,269 patients with intermediate-thickness (defined as 1.2–3.5 mm in this study) primary melanomas. The primary end point was melanoma-specific survival.[15][Level of evidence A1]

At a median follow-up of 59.8 months, there was no melanoma-specific survival advantage for patients randomly assigned to undergo wide excision plus SLNB, followed by immediate completion lymphadenectomy for node positivity versus nodal observation and delayed lymphadenectomy for subsequent nodal recurrence.

The International Multicenter Selective Lymphadenectomy Trial (MSLT-1) included 1,269 patients with intermediate-thickness (defined as 1.2–3.5 mm in this study) primary melanomas. The primary end point was melanoma-specific survival.[15][Level of evidence A1]

This trial was not designed to detect a difference in the impact of lymphadenectomy in patients with microscopic lymph node involvement.

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.[13][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.[13][Level of evidence A1]

At a follow-up of 3 years, there was no melanoma-specific survival advantage for patients randomly assigned to undergo either completion lymphadenectomy versus nodal observation with ultrasound and delayed lymphadenectomy for subsequent nodal recurrence (86% [±1.3%] vs. 86% [±1.2%]; hazard ratio [HR], 1.08; 95% confidence interval [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.[13][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.[13][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.[13][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.[13][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 >1 mm in diameter) 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 either completion lymphadenectomy (n = 240) or observation (n = 233). The primary end point was DMFS.[14][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 either completion lymphadenectomy (n = 240) or observation (n = 233). The primary end point was DMFS.[14][Level of evidence B1]

At a median follow-up of 35.5 months, there was no difference in DMFS in 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 = 0.87).

The DeCOG-SLT trial (NCT02434107) included 483 patients with primary melanoma and microscopically detected nodal metastases. Patients were randomly assigned to undergo either completion lymphadenectomy (n = 240) or observation (n = 233). The primary end point was DMFS.[14][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 either completion lymphadenectomy (n = 240) or observation (n = 233). The primary end point was DMFS.[14][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).