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Sentinel Lymph Node Biopsy and Completion Lymph Node Dissection for Melanoma

  • Skin Cancer (T Ito, Section Editor)
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A Correction to this article was published on 29 August 2019

This article has been updated

Opinion statement

This review critically evaluates recent trials which have challenged the practice of completion lymph node dissection (CLND) for melanoma patients diagnosed with regional metastasis by positive sentinel lymph node biopsy (SLNB). Two trials in the last 2 years, DeCOG-SLT and MSLT-II, found no significant differences in melanoma-specific survival between patients, whether they received immediate CLND or observation after positive SLNB, despite decreases in nodal recurrence achieved by dissection. These trials together disfavor routine CLND in most patients after positive SLNB. However, their conclusions are limited by study populations which overall harbored a lower burden of SLN disease. Special attention needs to be given to patients who do have higher risk disease, with SLN tumor burdens exceeding 1 mm in diameter, for whom CLND may remain both prognostic and therapeutic. Current guidelines thus recommend either CLND or careful observation after positive SLNB after appropriate risk stratification of patients. While a decline in CLND is inevitable, treatment of stage III melanoma is witnessing the concurrent rise of effective adjuvant therapies. PD-1 inhibitors such as nivolumab, or combination BRAF/MEK inhibitors for V600E or K mutant melanoma, which were previously available to only trial patients with completely resected stage III disease, are now approved for use in patients with positive SLNB alone. Providers are better equipped than ever to treat clinically occult, regional metastatic disease with SLNB followed by adjuvant therapy for most patients, but should take steps to avoid undertreatment of high-risk patients who may proceed to disease relapse or progression.

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Change history

  • 29 August 2019

    The original version of this article, which published in Current Treatment Options in Oncology, Volume 19, Issue 11, November 2018, contained an error within the Conflict of Interest statements. It was originally stated that “Norma E. Farrow received support from an NIH T32 grant (T32-CA009111.”

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Authors and Affiliations

  1. Department of Surgery, Duke University, Durham, NC, 27710, USA

    Sabran J. Masoud BS, Norma E. Farrow MD, Paul J. Mosca MD, PhD, MBA & Georgia M. Beasley MD, MHS

  2. Department of Surgery, University Texas Medical Branch, Galveston, TX, USA

    Jennifer A. Perone MD & Douglas S. Tyler MD

  3. Duke University Medical Center, DUMC Box 3118, Durham, NC, 27710, USA

    Georgia M. Beasley MD, MHS

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Correspondence to Georgia M. Beasley MD, MHS.

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Conflict of Interest

Sabran J. Masoud received support for travel for the 2018 Melanoma Research Alliance Conference from the PolkaDot Mama Melanoma Research Foundation.

Jennifer A. Perone is supported by a Clinical and Translational Science Award Linked Training (TL1) Award from the National Center of Advancing Translational Sciences, National Institutes of Health (NIH) (TL1TR001440).

Norma E. Farrow received support from an NIH T32 grant (T32-CA009111).

Paul J. Mosca declares that he has no conflict of interest.

Douglas S. Tyler declares that he has no conflict of interest.

Georgia M. Beasley declares that she has no conflict of interest.

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Masoud, S.J., Perone, J.A., Farrow, N.E. et al. Sentinel Lymph Node Biopsy and Completion Lymph Node Dissection for Melanoma. Curr. Treat. Options in Oncol. 19, 55 (2018). https://doi.org/10.1007/s11864-018-0575-4

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