Is Completion Lymphadenectomy After a Positive Sentinel Lymph Node Biopsy for Cutaneous Melanoma Always Necessary?

Abstract

Hypothesis: Completion lymph node dissection (CLND) has usually been recommended after metastatic disease is identified in the sentinel lymph node (SLN) biopsy to eradicate further metastases in nonsentinel nodes. We hypothesized that patients with negative lymph nodes included in the initial SLN specimen have low risk of metastases in the residual draining basin and may not require CLND.

Predictive Factors for False Negative Sentinel Lymph Node in Melanoma Patients

“…For this reason it was included in the 2001 AJCC staging system for cutaneous melanoma. 13 SLNB diagnostic utility has been assessed by several authors; this technique avoids the need for a radical dissection in approximately 80% of patients. 9,[14][15][16] The staging accuracy and the prognostic value of SLNB are also confirmed by the results of the Multicenter Selective Lymphadenectomy Trial I.…”

The role of sentinel lymph node biopsy for melanoma: Evidence assessment

“…92 No current evidence supports omission of a CLND after a positive SLNB. [96][97][98][99][100][101][102][103][104] After a positive SLNB, 15% to 21% of patients have evidence of positive non-SLN metastases after CLND. This likely represents an underestimate because these nodes are neither serial sectioned nor stained with immunohistochemistry.…”

Prediction of Nonsentinel Lymph Node Metastasis in Malignant Melanoma

“…For those with a positive SLNB result, however, the next step in their management usually entails a completion lymph node dissection (CLND). CLND, which can impart significant morbidity, in turn yields negative results in about 80% of patients [1][2][3][4]. Morbidity rates of up to 60% have been reported to result from CLNDs [5,6].…”