Advertisement

Annals of Surgical Oncology

, Volume 25, Issue 2, pp 356–377 | Cite as

Sentinel Lymph Node Biopsy and Management of Regional Lymph Nodes in Melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Clinical Practice Guideline Update

  • Sandra L. Wong
  • Mark B. Faries
  • Erin B. Kennedy
  • Sanjiv S. Agarwala
  • Timothy J. Akhurst
  • Charlotte Ariyan
  • Charles M. Balch
  • Barry S. Berman
  • Alistair Cochran
  • Keith A. Delman
  • Mark Gorman
  • John M. Kirkwood
  • Marc D. Moncrieff
  • Jonathan S. Zager
  • Gary H. Lyman
Melanomas

Abstract

Purpose

To update the American Society of Clinical Oncology (ASCO)-Society of Surgical Oncology (SSO) guideline for sentinel lymph node (SLN) biopsy in melanoma.

Methods

An ASCO-SSO panel was formed, and a systematic review of the literature was conducted regarding SLN biopsy and completion lymph node dissection (CLND) after a positive sentinel node in patients with melanoma.

Results

Nine new observational studies, two systematic reviews and an updated randomized controlled trial (RCT) of SLN biopsy, as well as two randomized controlled trials of CLND after positive SLN biopsy, were included.

Recommendations

Routine SLN biopsy is not recommended for patients with thin melanomas that are T1a (non-ulcerated lesions < 0.8 mm in Breslow thickness). SLN biopsy may be considered for thin melanomas that are T1b (0.8 to 1.0 mm Breslow thickness or <0.8 mm Breslow thickness with ulceration) after a thorough discussion with the patient of the potential benefits and risk of harms associated with the procedure. SLN biopsy is recommended for patients with intermediate-thickness melanomas (T2 or T3; Breslow thickness of >1.0 to 4.0 mm). SLN biopsy may be recommended for patients with thick melanomas (T4; > 4.0 mm in Breslow thickness), after a discussion of the potential benefits and risks of harm. In the case of a positive SLN biopsy, CLND or careful observation are options for patients with low-risk micrometastatic disease, with due consideration of clinicopathological factors. For higher risk patients, careful observation may be considered only after a thorough discussion with patients about the potential risks and benefits of foregoing CLND. Important qualifying statements outlining relevant clinicopathological factors, and details of the reference patient populations are included within the guideline.

Notes

Acknowledgement

The Expert Panel thanks Jeffrey Kirshner, MD, Geoffrey Gibney, MD, and Jean Rene Clemenceau, MD, and the Clinical Practice Guidelines Committee for their thoughtful reviews and insightful comments on this guideline.

Disclosures

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO’s conflict of interest policy, please refer to www.asco.org/rwc or www.ascopubs.org/jco/site/ifc. Sandra L. Wong: no relationship to disclose. Mark B. Faries: Consulting or Advisory Role: Immune Design, Delcath Systems, Novartis, Castle Biosciences. Erin B. Kennedy: No relationship to disclose. Sanjiv S. Agarwala: Travel, Accommodations, Expenses: MSD, Bristol-Myers Squibb. Timothy J. Akhurst: Employment: Intellerad (I), Stock or Other Ownership: Perkin Elmer (I). Charlotte Ariyan: Employment: Pfizer (I), Stock or Other Ownership: Pfizer (I). Charles M. Balch: Honoraria: Merck, Merck Sharp & Dohme, Consulting or Advisory Role: Merck, Travel, Accommodations, Expenses: Merck, Merck Sharp & Dohme. Barry S. Berman: Consulting or Advisory Role: Bristol-Myers Squibb, Bayer, Genentech, Alexion Pharmaceuticals, Axess Oncology. Alistair Cochran: No relationship to disclose. Keith A. Delman: No relationship to disclose. Mark Gorman: No relationship to disclose. John M. Kirkwood: Consulting or Advisory Role: Bristol-Myers Squibb, Novartis, Genentech/Roche, EMD Serono, Array BioPharma, Merck. Research Funding: Prometheus (Inst), Merck (Inst). Marc D. Moncrieff: No relationship to disclose. Jonathan S. Zager: Honoraria: Amgen, Consulting or Advisory Role: Amgen, Castle Biosciences, Delcath Systems, Speakers’ Bureau: Amgen, Research Funding: Amgen (Inst), Castle Biosciences (Inst), Delcath Systems (Inst), Provectus (Inst). Travel, Accommodations, Expenses: Amgen. Gary H. Lyman: Consulting or Advisory Role: Halozyme, G1 Therapeutics, Coherus Biosciences. Research Funding: Amgen (Inst)

Supplementary material

10434_2017_6267_MOESM1_ESM.docx (13 kb)
Supplementary material 1 (DOCX 13 kb)
10434_2017_6267_MOESM2_ESM.docx (54 kb)
Supplementary material 2 (DOCX 53 kb)
10434_2017_6267_MOESM3_ESM.docx (57 kb)
Supplementary material 3 (DOCX 57 kb)

References

  1. 1.
  2. 2.
    American Cancer Society: key statistics for melanoma skin cancer. https://www.cancer.org/cancer/melanoma-skin-cancer/about/key-statistics.html
  3. 3.
    Balch CM, Gershenwald JE: Clinical value of the sentinel-node biopsy in primary cutaneous melanoma. N Engl J Med. 370:663-664, 2014.  https://doi.org/10.1056/NEJMe1313690 CrossRefPubMedGoogle Scholar
  4. 4.
    Balch CM, Gershenwald JE, Soong SJ, et al: Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 27:6199-6206, 2009.  https://doi.org/10.1200/JCO.2009.23.4799 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Balch CM, Gershenwald JE, Soong SJ, et al: Update on the melanoma staging system: the importance of sentinel node staging and primary tumor mitotic rate. J Surg Oncol. 104:379-385, 2011.  https://doi.org/10.1002/jso.21876 CrossRefPubMedGoogle Scholar
  6. 6.
    Wong SL, Balch CM, Hurley P, et al: Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology joint clinical practice guideline. J Clin Oncol. 30:2912-2918, 2012.  https://doi.org/10.1200/JCO.2011.40.3519 CrossRefPubMedGoogle Scholar
  7. 7.
    Wong SL, Balch CM, Hurley P, et al: Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology joint clinical practice guideline. Ann Surg Oncol. 19:3313-3324, 2012.  https://doi.org/10.1245/s10434-012-2475-3 CrossRefPubMedGoogle Scholar
  8. 8.
    Valsecchi ME, Silbermins D, de Rosa N, et al: Lymphatic mapping and sentinel lymph node biopsy in patients with melanoma: a meta-analysis. J Clin Oncol. 29:1479-1487, 2011.  https://doi.org/10.1200/JCO.2010.33.1884 CrossRefPubMedGoogle Scholar
  9. 9.
    Shiffman RN, Michel G, Rosenfeld RM, et al: Building better guidelines with BRIDGE-Wiz: development and evaluation of a software assistant to promote clarity, transparency, and implementability. J Am Med Inform Assoc. 19:94-101, 2012.  https://doi.org/10.1136/amiajnl-2011-000172 CrossRefPubMedGoogle Scholar
  10. 10.
    Shojania KG, Sampson M, Ansari MT, et al: How quickly do systematic reviews go out of date? A survival analysis. Ann Intern Med. 147:224-233, 2007.  https://doi.org/10.7326/0003-4819-147-4-200708210-00179 CrossRefPubMedGoogle Scholar
  11. 11.
    Morton DL, Thompson JF, Cochran AJ, et al: Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med. 370:599-609, 2014.  https://doi.org/10.1056/NEJMoa1310460 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Kachare SD, Singla P, Vohra NA, et al: Sentinel lymph node biopsy is prognostic but not therapeutic for thick melanoma. Surgery. 158:662-668, 2015.  https://doi.org/10.1016/j.surg.2015.05.012 CrossRefPubMedGoogle Scholar
  13. 13.
    Ribero S, Osella-Abate S, Sanlorenzo M, et al: Sentinel lymph node biopsy in thick-melanoma patients (N=350): what is its prognostic role? Ann Surg Oncol. 22:1967-1973, 2015.  https://doi.org/10.1245/s10434-014-4211-7 CrossRefPubMedGoogle Scholar
  14. 14.
    Kachare SD, Brinkley J, Wong JH, et al: The influence of sentinel lymph node biopsy on survival for intermediate-thickness melanoma. Ann Surg Oncol. 21:3377-3385, 2014.  https://doi.org/10.1245/s10434-014-3954-5 CrossRefPubMedGoogle Scholar
  15. 15.
    Sperry SM, Charlton ME, Pagedar NA: Association of sentinel lymph node biopsy with survival for head and neck melanoma: survival analysis using the SEER database. JAMA Otolaryngol Head Neck Surg. 140:1101-1109, 2014.  https://doi.org/10.1001/jamaoto.2014.2530 CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    van der Ploeg AP, Haydu LE, Spillane AJ, et al: Outcome following sentinel node biopsy plus wide local excision versus wide local excision only for primary cutaneous melanoma: analysis of 5840 patients treated at a single institution. Ann Surg. 260:149-157, 2014.  https://doi.org/10.1097/SLA.0000000000000500 CrossRefPubMedGoogle Scholar
  17. 17.
    Cordeiro E, Gervais MK, Shah PS, et al: Sentinel lymph node biopsy in thin cutaneous melanoma: a systematic review and meta-analysis. Ann Surg Oncol. 23:4178-4188, 2016.  https://doi.org/10.1245/s10434-016-5137-z CrossRefPubMedGoogle Scholar
  18. 18.
    Kirkland EB, Zitelli JA: Mitotic rate for thin melanomas: should a single mitotic figure warrant a sentinel lymph node biopsy? Dermatol Surg. 40:937-945, 2014.  https://doi.org/10.1097/01.DSS.0000452619.94264.ff CrossRefPubMedGoogle Scholar
  19. 19.
    Wat H, Senthilselvan A, Salopek TG: A retrospective, multicenter analysis of the predictive value of mitotic rate for sentinel lymph node (SLN) positivity in thin melanomas. J Am Acad Dermatol. 74:94-101, 2016.  https://doi.org/10.1016/j.jaad.2015.09.014 CrossRefPubMedGoogle Scholar
  20. 20.
    Bartlett EK, Peters MG, Blair A, et al: Identification of patients with intermediate thickness melanoma at low risk for sentinel lymph node positivity. Ann Surg Oncol. 23:250-256, 2016.  https://doi.org/10.1245/s10434-015-4766-y CrossRefPubMedGoogle Scholar
  21. 21.
    Balch CM, Thompson JF, Gershenwald JE, et al: Age as a predictor of sentinel node metastasis among patients with localized melanoma: an inverse correlation of melanoma mortality and incidence of sentinel node metastasis among young and old patients. Ann Surg Oncol. 21:1075-1081, 2014.  https://doi.org/10.1245/s10434-013-3464-x CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    McClain SE, Shada AL, Barry M, et al: Outcome of sentinel lymph node biopsy and prognostic implications of regression in thin malignant melanoma. Melanoma Res. 22:302-309, 2012.  https://doi.org/10.1097/CMR.0b013e328353e673 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    The Cochrane Collaboration: Part 12.2 Assessing the quality of a body of evidence, in Higgins JPT, Green S (eds): Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0, March 2011. http://handbook-5-1.cochrane.org/
  24. 24.
    Kyrgidis A, Tzellos T, Mocellin S, et al: Sentinel lymph node biopsy followed by lymph node dissection for localised primary cutaneous melanoma. Cochrane Database Syst Rev. 5:CD010307, 2015.Google Scholar
  25. 25.
    Han D, Zager JS, Shyr Y, et al: Clinicopathological predictors of sentinel lymph node metastasis in thin melanoma. J Clin Oncol. 31:4387-4393, 2013.  https://doi.org/10.1200/JCO.2013.50.1114 CrossRefPubMedGoogle Scholar
  26. 26.
    Leiter U, Stadler R, Mauch C, et al: Complete lymph node dissection versus no dissection in patients with sentinel lymph node biopsy positive melanoma (DeCOG-SLT): a multicentre, randomised, phase 3 trial. Lancet Oncol. 17:757-767, 2016.  https://doi.org/10.1016/S1470-2045(16)00141-8 CrossRefPubMedGoogle Scholar
  27. 27.
    Faries MB, Thompson JF, Cochran AJ, et al: Completion dissection or observation for sentinel-node metastasis in melanoma. N Engl J Med. 376:2211-2222, 2017.  https://doi.org/10.1056/NEJMoa1613210 CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Boland GM, Gershenwald JE: Principles of melanoma staging. Cancer Treat Res. 167:131-148, 2016.  https://doi.org/10.1007/978-3-319-22539-5_5 CrossRefPubMedGoogle Scholar
  29. 29.
    Cigna E, Gradilone A, Ribuffo D, et al: Morbidity of selective lymph node biopsy for melanoma: meta-analysis of complications. Tumori. 98:94-98, 2012Google Scholar
  30. 30.
    Morton DL, Thompson JF, Cochran AJ, et al: Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 355:1307-1317, 2006.  https://doi.org/10.1056/NEJMoa060992 CrossRefPubMedGoogle Scholar
  31. 31.
    Kimbrough CW, Egger ME, McMasters KM, et al: Molecular staging of sentinel lymph nodes identifies melanoma patients at increased risk of nodal recurrence. J Am Coll Surg. 222:357-363, 2016.  https://doi.org/10.1016/j.jamcollsurg.2015.12.042 CrossRefPubMedGoogle Scholar
  32. 32.
    Eggermont AM, Suciu S, Testori A, et al: Ulceration and stage are predictive of interferon efficacy in melanoma: results of the phase III adjuvant trials EORTC 18952 and EORTC 18991. Eur J Cancer. 48:218-225, 2012.  https://doi.org/10.1016/j.ejca.2011.09.028 CrossRefPubMedGoogle Scholar
  33. 33.
    Kingham TP, Panageas KS, Ariyan CE, et al: Outcome of patients with a positive sentinel lymph node who do not undergo completion lymphadenectomy. Ann Surg Oncol. 17:514-520, 2010CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    US Cancer Statistics Working Group: United States cancer statistics: 1999–2012 incidence and mortality web-based report.www.cdc.gov/uscs
  35. 35.
    Howlader N, Noone AM, Krapcho M, et al: SEER cancer statistics review, 1975-2013. http://seer.cancer.gov/csr/1975_2013
  36. 36.
    Mead H, Cartwright-Smith L, Jones K, et al: Racial and Ethnic Disparities in U.S. Health Care: A Chartbook. New York, NY, The Commonwealth Fund, 2008Google Scholar
  37. 37.
    American Cancer Society: Cancer facts and figures for African Americans 2016-2018. http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-047403.pdf
  38. 38.
    Schnipper LE, Davidson NE, Wollins DS, et al: American Society of Clinical Oncology statement: a conceptual framework to assess the value of cancer treatment options. J Clin Oncol. 33:2563-2577, 2015.  https://doi.org/10.1200/JCO.2015.61.6706 CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Streeter SB, Schwartzberg L, Husain N, et al: Patient and plan characteristics affecting abandonment of oral oncolytic prescriptions. J Oncol Pract. 746s-51s, 2011(3, suppl).  https://doi.org/10.1200/JOP.2011.000316
  40. 40.
    Dusetzina SB, Winn AN, Abel GA, et al: Cost sharing and adherence to tyrosine kinase inhibitors for patients with chronic myeloid leukemia. J Clin Oncol. 32:306-311, 2014.  https://doi.org/10.1200/JCO.2013.52.9123 CrossRefPubMedGoogle Scholar
  41. 41.
    Meropol NJ, Schrag D, Smith TJ, et al: American Society of Clinical Oncology guidance statement: the cost of cancer care. J Clin Oncol. 27:3868-3874, 2009.  https://doi.org/10.1200/JCO.2009.23.1183 CrossRefPubMedGoogle Scholar
  42. 42.
    Andersen BL, DeRubeis RJ, Berman BS, et al: Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American Society of Clinical Oncology guideline adaptation. J Clin Oncol. 32:1605-1619, 2014.  https://doi.org/10.1200/JCO.2013.52.4611 CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Ferrell BR, Temel JS, Temin S, et al: Integration of palliative care into standard oncology care: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 35:96-112, 2017.  https://doi.org/10.1200/JCO.2016.70.1474 CrossRefPubMedGoogle Scholar
  44. 44.
    Gilligan T, Coyle N, Frankel RM, et al: Patient-clinician communication: American Society of Clinical Oncology consensus guideline. J Clin Oncol. 35:3618-3632, 2017CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Sandra L. Wong
    • 1
  • Mark B. Faries
    • 2
  • Erin B. Kennedy
    • 4
  • Sanjiv S. Agarwala
    • 5
  • Timothy J. Akhurst
    • 7
  • Charlotte Ariyan
    • 8
  • Charles M. Balch
    • 9
  • Barry S. Berman
    • 10
  • Alistair Cochran
    • 3
  • Keith A. Delman
    • 12
  • Mark Gorman
    • 13
  • John M. Kirkwood
    • 6
  • Marc D. Moncrieff
    • 14
  • Jonathan S. Zager
    • 11
  • Gary H. Lyman
    • 15
  1. 1.Dartmouth-Hitchcock Medical CenterLebanonUSA
  2. 2.The Angeles Clinic and Research InstituteSanta MonicaUSA
  3. 3.Los Angeles Center for Health ServicesUniversity of CaliforniaLos AngelesUSA
  4. 4.American Society of Clinical OncologyAlexandriaUSA
  5. 5.St Luke’s Cancer CenterEastonUSA
  6. 6.University of Pittsburgh Cancer InstitutePittsburghUSA
  7. 7.Peter MacCallum Cancer CentreMelbourneAustralia
  8. 8.Memorial Sloan Kettering Cancer CenterNew YorkUSA
  9. 9.MD Anderson Cancer CenterHoustonUSA
  10. 10.Broward HealthFort LauderdaleUSA
  11. 11.H. Lee Moffitt Cancer Center and Research InstituteTampaUSA
  12. 12.Emory UniversityAtlantaUSA
  13. 13.Silver SpringUSA
  14. 14.Norfolk and Norwich University HospitalNorwichUK
  15. 15.Fred Hutchinson Cancer Research CenterSeattleUSA

Personalised recommendations