Long-term outcomes of nodal surveillance practices in sentinel node positive melanoma: An early post MSLT-II cohort

Victoria Jiminez; Kelsey B Montgomery; Britany Hollenquest; Kristy K Broman

doi:10.1016/j.amjsurg.2024.116049

Long-term outcomes of nodal surveillance practices in sentinel node positive melanoma: An early post MSLT-II cohort

Am J Surg. 2024 Oct 29:239:116049. doi: 10.1016/j.amjsurg.2024.116049. Online ahead of print.

Authors

Victoria Jiminez¹, Kelsey B Montgomery², Britany Hollenquest³, Kristy K Broman⁴

Affiliations

¹ Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: vjiminez@uab.edu.
² Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
³ Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA.
⁴ Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Veterans Affairs, Birmingham VA Medical Center, Birmingham, AL, USA.

PMID: 39509939
DOI: 10.1016/j.amjsurg.2024.116049

Abstract

Background: The Second Multicenter Selective Lymphadenectomy Trial (MSLT-II), published in 2017, demonstrated equivalent melanoma-specific survival between nodal surveillance and completion lymph node dissection (CLND) for sentinel lymph node (SLN) positive melanoma. This study evaluated outcomes of nodal surveillance in an early post-MSLT-II institutional cohort.

Methods: Included patients received nodal surveillance from 2017 to 2023. Primary outcomes were nodal basin and any site recurrence. Kaplan Meier curves and Cox proportional hazard models were used to evaluate recurrence-free survial and associated factors.

Results: This 212 patient cohort (median age 61 years, 57.7 % male, 96.7 % white) had median primary tumor depth of 1.9 mm and one positive SLN. Sixty-three patients (29.7 %) recurred at 23 month median follow-up. Sixty percent received adjuvant therapy. Any site and nodal basin recurrence-free survival were 58.3 % and 80.9 % at 3 years. On adjusted analysis, older age and head/neck primary site were associated with worse recurrence-free survival.

Conclusion: Long-term outcomes at a single institution were comparable to clinical trial findings. Nodal surveillance remains a feasible management strategy for SLN + melanoma.

Keywords: Melanoma; Nodal surveillance; Outcomes; Recurrence; SLN+ melanoma.