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National Practice Patterns in the Management of the Regional Lymph Node Basin After Positive Sentinel Lymph Node Biopsy for Cutaneous Melanoma

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

Abstract

Background

Immediate completion lymph node dissection (CLND) for patients with sentinel lymph node (SLN) metastasis from cutaneous melanoma has been replaced largely by ultrasound nodal surveillance since the publication of two landmark trials in 2016 and 2017. National practice patterns of CLND remain poorly characterized.

Methods

Patients with a diagnosis of cutaneous melanoma in 2016 and 2018 without clinical nodal disease who underwent sentinel lymph node biopsy (SLNB) were identified from the National Cancer Database (NCDB). Characteristics associated with CLND were analyzed by uni- and multivariate logistic regression. Overall survival (OS) was estimated using Kaplan-Meier and Cox proportional hazards regression analyses.

Results

Of the 3517 patients included in the study, 1405 had disease diagnosed in 2016. The patients with cutaneous melanoma diagnosed in 2016 had a median age of 60 years and a tumor thickness of 2.3 mm compared to 62 years and 2.4 mm, respectively, for the patients with cutaneous melanoma diagnosed in 2018. According to the NCDB, 40 % (n = 559) of the patients underwent CLND in 2016 compared with 6 % (n = 132) in 2018. The factors associated with receipt of CLND in 2018 included younger age (odds ratio [OR], 0.97; 95 % confidence interval [CI], 0.95–0.99; p = 0.001), rural residence (OR, 3.96; 95 % CI, 1.50–10.49; p = 0.006), head/neck tumor location (OR, 1.88; 95 % CI, 1.10–3.23; p = 0.021), and more than one positive SLN (OR, 1.80; 95 % CI, 1.17–2.76; p = 0.007). The 5-year OS did not differ between the patients who received SLNB only and those who underwent CLND (hazard ratio [HR], 0.93; p = 0.54).

Conclusion

The rates of CLND have decreased nationally. However, patients with head/neck primary tumors who live in rural locations are more likely to undergo CLND, highlighting populations for which treatment may be non-uniform with national practice patterns.

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Funding

No funding was received for the completion of this study

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Authors and Affiliations

  1. Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Maloney 4, Philadelphia, 19104, PA, USA

    Cimarron E. Sharon MD, Richard J. Straker III MD, Giorgos C. Karakousis MD & John T. Miura MD

  2. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Eric H. Li BS

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  1. Cimarron E. Sharon MD
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  2. Richard J. Straker III MD
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Contributions

CS had full access to the data and takes responsibility for the integrity of the data and the accuracy of the analyses. Study conception or design: Sharon, Straker, Li, Miura, Karakousis. Data acquisition, analysis, or interpretation: Sharon, Straker, Li, Miura, Karakousis. Drafting or critically revising the work: Sharon, Straker, Li, Miura, Karakousis

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Correspondence to Cimarron E. Sharon MD.

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Sharon, C.E., Straker, R.J., Li, E.H. et al. National Practice Patterns in the Management of the Regional Lymph Node Basin After Positive Sentinel Lymph Node Biopsy for Cutaneous Melanoma. Ann Surg Oncol 29, 8456–8464 (2022). https://doi.org/10.1245/s10434-022-12364-9

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