Adjuvant Therapy is Effective for Melanoma Patients with a Positive Sentinel Lymph Node Biopsy Who Forego Completion Lymphadenectomy

European consensus-based interdisciplinary guideline for melanoma. Part 2: Treatment - Update 2022

“…Considering the previous results, in patients with SLN micro-metastasis, CLND shall be abandoned [38]. Additionally, recent retrospective studies have shown that adjuvant therapy is offering similar outcomes in patients with microscopic nodal metastases not undergoing CLND than those achieved after CLND in clinical trial settings [44,45]. For information regarding adjuvant systemic therapy in stage III melanoma please refer to section 3 of this guideline.…”

Active surveillance of patients who have melanoma with a positive sentinel node in an era of effective adjuvant therapy: Early lessons learned … and still learning

“…Because the limited follow‐up may be considered insufficient to robustly examine DSS and distant metastasis‐free survival, it is not surprising that exploratory analyses noted no differences by nodal management approach or adjuvant therapy; longer follow‐up is clearly warranted to allow these initial patterns of recurrence and survival estimates to mature. One relatively small, single‐institution study reported on 32 patients who had a positive SLN and were followed with active surveillance 21 . At a median follow‐up of 13 months, 22% of those patients had recurred, including 18% of those who received adjuvant therapy and 30% of those who did not.…”

Applying adjuvant therapy for melanoma into clinical practice

“…This approach may potentially downstage patients, and there is the possibility that more locoregional (nodal) recurrences may be seen; however, adjuvant therapies should similarly reduce locoregional and distant recurrence. Recent real-world data for patients with a positive SLNB who underwent adjuvant systemic therapy and no CLND showed similar RFS outcomes to those seen in the adjuvant therapy trials [32]. Some centers recommend regular ultrasound monitoring of nodal basins in those who do not undergo CLND, however, whether this adds value over regular PET/CT scans remains unknown at this time.…”