Surveillance of Sentinel Node-Positive Melanoma Patients with Reasons for Exclusion from MSLT-II: Multi-Institutional Propensity Score Matched Analysis

Broman, Kristy Kummerow; Hughes, Tasha M.; Dossett, Lesly A.; Sun, James; Carr, Michael J.; Кириченко, Д. А.; Sharma, Avinash; Bartlett, Edmund K.; Nijhuis, Amanda A. G.; Thompson, John F.; Hieken, Tina J.; Kottschade, Lisa A.; Downs, Jennifer; Gyorki, David E.; Stahlie, Emma H. A.; Akkooi, Alexander C. J. van; Ollila, David W.; Frank, Jill S.; Song, Yun Seon; Karakousis, Giorgos C.; Moncrieff, Marc; Nobes, Jenny; Vetto, John T.; Han, Dale; Farma, Jeffrey M.; Deneve, Jeremiah L.; Fleming, Martin D.; Perez, Matthew C.; Baecher, Kirsten; Lowe, Michael C.; Bagge, Roger Olofsson; Mattsson, Jan; Lee, Ann Y.; Berman, Russell S.; Chai, Harvey; Kroon, Hidde M.; Teras, Roland M.; Teras, J; Farrow, Norma E.; Beasley, Georgia M.; Hui, Jane Yc; Been, Lukas B.; Kruijff, Schelto; Boulware, David; Sarnaik, Amod A.; Sondak, Vernon K.; Zager, Jonathan S.

doi:10.1016/j.jamcollsurg.2020.11.014

Cited by 17 publications

(13 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Tidligere var komple erende lymfeknutedisseksjon standardbehandling for å hindre regionalt residiv og y erligere spredning av sykdommen. I dag anbefales ikke de e lenger rutinemessig (16,17).…”

Section: Vaktpostlymfeknutediagnostikkunclassified

Melanoma – investigation and primary treatment

Berentzen¹,

Brevig

Hermann

et al. 2022

Tidsskriftet

View full text Add to dashboard Cite

Section: Vaktpostlymfeknutediagnostikkunclassified

Melanoma – investigation and primary treatment

Berentzen¹,

Brevig

Hermann

et al. 2022

Tidsskriftet

View full text Add to dashboard Cite

“…This may stem from provider-level unease about the generalizability of the MLST-II results to patients with increasing SLN disease burden given that the majority of patients included in the MLST-II trial only had one positive SLN and tumor deposits less than 1.0 mm in size. 31 Furthermore, patients with extracapsular extension were excluded from the study population. 9 The results of this study also support previous findings that have demonstrated how the use of CLND for melanoma varies according One hypothesis is that surgeons may be more resistant to offer groin dissection to patients due to the increased rate of morbidity, including lymphedema associated with inguinal surgery.…”

Section: Resultsmentioning

confidence: 99%

“…Additionally, a recent survey by Hui et al 30 revealed that surgeons selectively offer CLND to patients with high‐risk features. This may stem from provider‐level unease about the generalizability of the MLST‐II results to patients with increasing SLN disease burden given that the majority of patients included in the MLST‐II trial only had one positive SLN and tumor deposits less than 1.0 mm in size 31 . Furthermore, patients with extracapsular extension were excluded from the study population 9 …”

Section: Discussionmentioning

confidence: 99%

Unmeasured factors are associated with the use of completion lymph node dissection (CLND) in melanoma

Leonard

Beaty

Thomas

et al. 2022

Journal of Surgical Oncology

View full text Add to dashboard Cite

Background Completion lymph node dissection (CLND) was the standard treatment for patients with melanoma with positive sentinel lymph nodes (SLN) until 2017 when data from the DeCOG‐SLT and MLST‐2 randomized trials challenged the survival benefit of this procedure. We assessed the contribution of patient, tumor and facility factors on the use of CLND in patients with surgically resected Stage III melanoma. Methods Using the National Cancer Database, patients who underwent surgical excision and were found to have a positive SLN from 2012 to 2017 were included. A multivariable mixed‐effects logistic regression model with a random intercept for the facility was used to determine the effect of patient, tumor, and facility variables on the risk of CLND. Reference effect measures (REMs) were used to compare the contribution of contextual effects (unknown facility variables) versus measured variables on the variation in CLND use. Results From 2012 to 2017, the overall use of CLND decreased from 59.9% to 26.5% (p < 0.0001). Overall, older patients and patients with government‐based insurance were less likely to undergo CLND. Tumor factors associated with a decreased rate of CLND included primary tumor location on the lower limb, decreasing depth, and mitotic rate <1. However, the contribution of contextual effects to the variation in CLND use exceeded that of the measured facility, tumor, time, and patient variables. Conclusions There was a decrease in CLND use during the study period. However, there is still high variability in CLND use, mainly driven by unmeasured contextual effects.

show abstract

“…Nodal surveillance is typically discontinued after five years [ 38 , 81 ]. CLND may be indicated in lieu of nodal surveillance if access to surveillance imaging is logistically challenging, if the primary tumour histology and nodal tumour burden suggest an increased likelihood of nodal involvement and/or recurrence, or when adjuvant therapy will not be pursued [ 38 , 81 , 82 , 83 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 ].…”

Section: Management Of Positive Sentinel Nodesmentioning

confidence: 99%

The Evolution of the Sentinel Node Biopsy in Melanoma

Allard-Coutu

Dobson

Schmitz

et al. 2023

Life

View full text Add to dashboard Cite

The growing repertoire of approved immune-checkpoint inhibitors and targeted therapy has revolutionized the adjuvant treatment of melanoma. While the treatment of primary cutaneous melanoma remains wide local excision (WLE), the management of regional lymph nodes continues to evolve in light of practice-changing clinical trials and dramatically improved adjuvant therapy. With large multicenter studies reporting no benefit in overall survival for completion lymph node dissection (CLND) after a positive sentinel node biopsy (SLNB), controversy remains regarding patient selection and clinical decision-making. This review explores the evolution of the SLNB in cutaneous melanoma in the context of a rapidly changing adjuvant treatment landscape, summarizing the key clinical trials which shaped current practice guidelines.

show abstract

Surveillance of Sentinel Node-Positive Melanoma Patients with Reasons for Exclusion from MSLT-II: Multi-Institutional Propensity Score Matched Analysis

Cited by 17 publications

References 16 publications

Melanoma – investigation and primary treatment

Melanoma – investigation and primary treatment

Unmeasured factors are associated with the use of completion lymph node dissection (CLND) in melanoma

The Evolution of the Sentinel Node Biopsy in Melanoma

Contact Info

Product

Resources

About