Melanoma patients with positive sentinel nodes who did not undergo completion lymphadenectomy

A multi-institutional study

Sandra L. Wong, Donald L. Morton, John F. Thompson, Jeffrey E. Gershenwald, Stanley P L Leong, Douglas S. Reintgen, Haim Gutman, Michael S. Sabel, Grant W. Carlson, Kelly M. McMasters, Douglas Tyler, James S. Goydos, Alexander M M Eggermont, Omgo E. Nieweg, A. Benedict Cosimi, Adam I. Riker, Daniel G. Coit

Research output: Contribution to journalArticle

114 Citations (Scopus)

Abstract

Background: Completion lymph node dissection (CLND) is considered the standard of care in melanoma patients found to have sentinel lymph node (SLN) metastasis. However, the therapeutic utility of CLND is not known. The natural history of patients with positive SLNs who do not undergo CLND is undefined. This multi-institutional study was undertaken to characterize patterns of failure and survival rates in these patients and to compare results with those of positive-SLN patients who underwent CLND. Methods: Surgeons from 16 centers contributed data on 134 positive-SLN patients who did not undergo CLND. SLN biopsy was performed by using each institution's established protocols. Patients were followed up for recurrence and survival. Results: In this study population, the median age was 59 years, and 62% were male. The median tumor thickness was 2.6 mm, 77% of tumors had invasion to Clark level IV/V, and 33% of lesions were ulcerated. The primary melanoma was located on the extremities, trunk, and head/neck in 45%, 43%, and 12%, respectively. The median follow-up was 20 months. The median time to recurrence was 11 months. Nodal recurrence was a component of the first site of recurrence in 20 patients (15%). Nodal recurrence-free survival was statistically insignificantly worse than that seen in a contemporary cohort of patients who underwent CLND. Disease-specific survival for positive-SLN patients who did not undergo CLND was 80% at 36 months, which was not significantly different from that of patients who underwent CLND. Conclusions: This study underscores the importance of ongoing prospective randomized trials in determining the therapeutic value of CLND after positive SLN biopsy in melanoma patients.

Original languageEnglish (US)
Pages (from-to)809-816
Number of pages8
JournalAnnals of Surgical Oncology
Volume13
Issue number6
DOIs
StatePublished - Jun 2006
Externally publishedYes

Fingerprint

Lymph Node Excision
Melanoma
Recurrence
Sentinel Lymph Node Biopsy
Survival
cyhalothrin
Standard of Care
Natural History
Neoplasms
Neck
Survival Rate
Extremities
Head
Neoplasm Metastasis
Sentinel Lymph Node

Keywords

  • Completion lymphadenectomy
  • Melanoma
  • Recurrence
  • Sentinel lymph node biopsy
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Wong, S. L., Morton, D. L., Thompson, J. F., Gershenwald, J. E., Leong, S. P. L., Reintgen, D. S., ... Coit, D. G. (2006). Melanoma patients with positive sentinel nodes who did not undergo completion lymphadenectomy: A multi-institutional study. Annals of Surgical Oncology, 13(6), 809-816. https://doi.org/10.1245/ASO.2006.03.058

Melanoma patients with positive sentinel nodes who did not undergo completion lymphadenectomy : A multi-institutional study. / Wong, Sandra L.; Morton, Donald L.; Thompson, John F.; Gershenwald, Jeffrey E.; Leong, Stanley P L; Reintgen, Douglas S.; Gutman, Haim; Sabel, Michael S.; Carlson, Grant W.; McMasters, Kelly M.; Tyler, Douglas; Goydos, James S.; Eggermont, Alexander M M; Nieweg, Omgo E.; Cosimi, A. Benedict; Riker, Adam I.; Coit, Daniel G.

In: Annals of Surgical Oncology, Vol. 13, No. 6, 06.2006, p. 809-816.

Research output: Contribution to journalArticle

Wong, SL, Morton, DL, Thompson, JF, Gershenwald, JE, Leong, SPL, Reintgen, DS, Gutman, H, Sabel, MS, Carlson, GW, McMasters, KM, Tyler, D, Goydos, JS, Eggermont, AMM, Nieweg, OE, Cosimi, AB, Riker, AI & Coit, DG 2006, 'Melanoma patients with positive sentinel nodes who did not undergo completion lymphadenectomy: A multi-institutional study', Annals of Surgical Oncology, vol. 13, no. 6, pp. 809-816. https://doi.org/10.1245/ASO.2006.03.058
Wong, Sandra L. ; Morton, Donald L. ; Thompson, John F. ; Gershenwald, Jeffrey E. ; Leong, Stanley P L ; Reintgen, Douglas S. ; Gutman, Haim ; Sabel, Michael S. ; Carlson, Grant W. ; McMasters, Kelly M. ; Tyler, Douglas ; Goydos, James S. ; Eggermont, Alexander M M ; Nieweg, Omgo E. ; Cosimi, A. Benedict ; Riker, Adam I. ; Coit, Daniel G. / Melanoma patients with positive sentinel nodes who did not undergo completion lymphadenectomy : A multi-institutional study. In: Annals of Surgical Oncology. 2006 ; Vol. 13, No. 6. pp. 809-816.
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abstract = "Background: Completion lymph node dissection (CLND) is considered the standard of care in melanoma patients found to have sentinel lymph node (SLN) metastasis. However, the therapeutic utility of CLND is not known. The natural history of patients with positive SLNs who do not undergo CLND is undefined. This multi-institutional study was undertaken to characterize patterns of failure and survival rates in these patients and to compare results with those of positive-SLN patients who underwent CLND. Methods: Surgeons from 16 centers contributed data on 134 positive-SLN patients who did not undergo CLND. SLN biopsy was performed by using each institution's established protocols. Patients were followed up for recurrence and survival. Results: In this study population, the median age was 59 years, and 62{\%} were male. The median tumor thickness was 2.6 mm, 77{\%} of tumors had invasion to Clark level IV/V, and 33{\%} of lesions were ulcerated. The primary melanoma was located on the extremities, trunk, and head/neck in 45{\%}, 43{\%}, and 12{\%}, respectively. The median follow-up was 20 months. The median time to recurrence was 11 months. Nodal recurrence was a component of the first site of recurrence in 20 patients (15{\%}). Nodal recurrence-free survival was statistically insignificantly worse than that seen in a contemporary cohort of patients who underwent CLND. Disease-specific survival for positive-SLN patients who did not undergo CLND was 80{\%} at 36 months, which was not significantly different from that of patients who underwent CLND. Conclusions: This study underscores the importance of ongoing prospective randomized trials in determining the therapeutic value of CLND after positive SLN biopsy in melanoma patients.",
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AU - Eggermont, Alexander M M

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AU - Coit, Daniel G.

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