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Real-World Adherence to Nodal Surveillance for Sentinel Lymph Node-Positive Melanoma

  • Melanoma
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Patients with sentinel lymph node-positive (SLN+) melanoma are increasingly undergoing active nodal surveillance over completion lymph node dissection (CLND) since the Second Multicenter Selective Lymphadenectomy Trial (MSLT-II). Adherence to nodal surveillance in real-world practice remains unknown.

Methods

In a retrospective cohort of SLN+ melanoma patients who underwent nodal surveillance at a single institution from July 2017 through April 2021, this study evaluated adherence to nodal surveillance ultrasound (US). Adherence to nodal US was compared with adherence to other surveillance methods based on receipt of adjuvant therapy. Early recurrence data were reported using descriptive statistics.

Results

Among 109 SLN+ patients, 37 (34%) received US surveillance at recommended intervals. Of the 72 (66%) non-adherent patients, 16 were lost to follow-up, and 33 had planned follow-up at an outside institution without available records. More patients had a minimum of bi-annual clinic visits (83%) and cross-sectional imaging (53%) compared to those who were adherent with nodal US. The patients who received adjuvant therapy (60%) had fewer ultrasounds (p < 0.01) but more exams (p < 0.01) and a trend toward more cross-sectional imaging (p = 0.06). Of the overall cohort, 26 patients (24%) experienced recurrence at a median follow-up period of 15 months. Of these recurrences, 10 were limited to the SLN basin, and all of these isolated nodal recurrences were resectable.

Conclusions

Pragmatic challenges to real-world delivery of nodal surveillance remain after MSLT-II, and adjuvant therapy appears to be associated with a decreased likelihood of US adherence. Understanding US utility alongside cross-sectional imaging will be critical as increasingly more patients undergo nodal surveillance and adjuvant therapy.

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Authors and Affiliations

  1. Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA

    Kelsey B. Montgomery MD & Kristy K. Broman MD, MPH

  2. Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    Tanya A. Correya BA

  3. Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA

    Kristy K. Broman MD, MPH

Authors
  1. Kelsey B. Montgomery MD
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  2. Tanya A. Correya BA
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  3. Kristy K. Broman MD, MPH
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Correspondence to Kelsey B. Montgomery MD.

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Montgomery, K.B., Correya, T.A. & Broman, K.K. Real-World Adherence to Nodal Surveillance for Sentinel Lymph Node-Positive Melanoma. Ann Surg Oncol 29, 5961–5968 (2022). https://doi.org/10.1245/s10434-022-11839-z

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  • DOI: https://doi.org/10.1245/s10434-022-11839-z

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