New England Surgical Society

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Changes in Lymphadenectomy patterns for Sentinel Node Positive Melanoma at a high Volume skin cancer center following MSLT II publication
Laurence E McCahill, *Mark Kosten, *Jensen Jantz
Metro Health University of Michigan Health, Grand Rapids, MI

Objective: We sought to evaluate trends in management of nodal basins in Stage III melanoma patients based on a positive Sentinel Lymph Node (SLN) biopsy following the publication of the MSLT II trial, and to assess the impact on disease recurrence patterns.
Design: A retrospective comparison from a prospectively maintained melanoma quality database. Differences across sample subgroups were compared using Chi-square testing.
Setting: University-Affiliated Community Hospital, high volume melanoma practice.
Patients: Patients with SLN+ invasive melanoma treated from September 2013 through December 2019. Patients with clinical adenopathy excludedMain Outcome Measures: Utilization of completion lymphadenectomy, and incidence of any nodal basin recurrence, and nodal only recurrence. Results: Among 440 patients undergoing resection for melanoma, there were 52 (11.8%) stage III on basis of positive SLN.
From Sept 2013- June 2017 (pre MSLT II), completion lymphadenectomy was performed in 12/14 (87.5%) patients vs. 8/38 (21.1%) from July 2017-December 2019, p<.001.
Adjuvant therapy use was 9/20 (45%) for patients who underwent lymphadenectomy and 17/32 (53.1%) for those undergoing nodal observation. Melanoma recurrence/death was observed in 7/20 (35.0%) lymphadenectomy (median f/u 36 mos) and in 10/32 (31.3%) nodal observation patients (median f/u of 15 months). Twelve-month recurrence free survival rates were: stage IIIa (n=19) 78.6%; stage IIIb (n=11) 62.5%, and stage IIIc/d (n=22) 30%. Any nodal recurrences was observed in 5/32 (15.6%) in the nodal observation group, but there were 0/32 patients with a nodal basin only relapse pattern. Conclusion: Nodal observation for patients with a positive SLN has been rapidly assimilated since publication of MSLT II trial. Nodal only recurrence appears uncommon, supporting wide adoption of lymph node observation for SLN+ patients, especially in stage IIIc disease.


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