Completion Lymph Node Dissection in Melanoma

Source: OncLive, December 2018

Transcript: 

Axel Hauschild, MD: The question is, what do we do with patients if the sentinel node is positive? Do we need a completion lymphadenectomy? I guess it’s very important to emphasize that the patients who have macrometastasis, palpable lymph nodes, nodes seen in the lymph node sonography, or in CT or MRI scanning, will be resected anyway with the completion of lymphadenectomy. That’s not the issue. It’s the tiny, positive sentinel node. We question if we need a completion lymphadenectomy. This is particularly being discovered in MSLT-II and in a German study. Mike, what is your gut feeling about the data? Is this changing the rules in your center.

Michael A. Davies, MD, PhD: Again, it’s part of the transformation we’re seeing in the care of melanoma patients. We’ll talk about the adjuvant therapy trials that have been completed, and we have to remember that those trials were completed in the era when patients were all getting completion lymph node dissection. We’re moving into an era that offers adjuvant therapies to patients who are undergoing sentinel lymph node biopsy without a completion lymph node dissection. I think we’re all going to be looking at how that sort of affects the risks of local and regional relapses. But absolutely, it’s very standard for us to do the sentinel lymph node biopsy. I would reinforce the idea for the patient who presents with a site that is 1 mm or thicker, but there are certainly considerations for patients with thinner melanomas but with high-risk features. Certainly, ulceration.

I think the other thing that’s good to remember is the signs of regression. With regression, you don’t actually know what the original Breslow thickness was. That’s something else that we look at when we’re talking about whether to do the sentinel lymph node biopsy. But you’re right, and I agree with the other panelists. It’s very unusual for us to do a completion lymph node dissection after a positive sentinel lymph node biopsy.