(Dallas—March 11, 2022, 1:11 p.m.) — Completion lymph node dissection (CLND) for tumor-positive sentinel lymph node biopsy (SLNB) is no longer recommended routinely in the treatment of melanoma, but omission of completion lymph node dissection may under-stage patients for whom the distinction between Stage IIIA and IIIB-D may alter adjuvant therapy recommendations.
To answer this question, Dr. Zachary J. Senders from the University of Louisville, Louisville, Ky., and colleagues examined records of patients in the National Cancer Database treated between 2012-2018 with cutaneous melanoma T1b or greater (thickness > 0.8 mm or with ulceration) and clinically node negative. Three cohorts were defined: 1) patients undergoing no lymph node procedure, 2) patients undergoing sentinel lymph node biopsy only, and 3) patients undergoing sentinel lymph node biopsy and completion lymph node dissection.
Dr. Senders presented his data at The Society of Surgical Oncology 2022 International Conference on Surgical Care.
Dr. Senders reported that of the 68,933 patients that met inclusion criteria, 60,536 underwent sentinel lymph node biopsy, of which 9,031 (14.9%) were tumor positive. A total of 3,776 (41.8%) underwent completion lymph node dissection. Patients receiving completion lymph node dissection were younger (58 vs 62, p < 0.0001) and more likely to be male (61.5% vs 57.9%, p=0.0005). Patients were more likely to have a higher N-classification (N2a-3a) if they received completion lymph node dissection (36.8%) compared to sentinel lymph node biopsy alone (19.3%), p < 0.0001.
Of the patients with stage T1b or T2a primary tumors, for whom the detection of additional positive lymph nodes would lead to upstaging from IIIA to IIIC, the incidence of IIIC disease was only slightly higher in those who underwent completion lymph node dissection compared to SLNB alone (4.4% vs 1.1%, p< 0.0001). The use of completion lymph node dissection dramatically decreased from 59% in 2012 to 12.6% in 2018, p < 0.0001. However, the incidence of Stage IIIA disease remained stable over the 7-year study period (p=0.29).
“While the utilization of Completion lymph node dissection after a positive SLNB has declined dramatically in the last seven years, stage migration that may affect adjuvant therapy decisions has not occurred to a significant degree,” Dr. Senders said.