Daniel Coit, MD
For patients with melanoma who have positive sentinel lymph nodes (SLNs), practitioners now have phase III evidence that suggests that complete lymph node dissection (CLND) is not more effective than observation and nodal ultrasonography.
The international, multicenter, randomized MSLT-II trial evaluated the efficacy of CLND in melanoma patients with SLN metastases (n = 824) compared with that of observation and nodal ultrasonography (n = 931). In the per-protocol analysis and at median follow-up of 43 months, the mean 3-year rate of melanoma-specific survival (MSS) was similar in the dissection group (86 ± 1.3%) and the observation group (86 ± 1.2%), respectively (P
= .42). The rate of disease-free survival was slightly higher in the dissection group than in the observation group (68 ± 1.7% and 63 ± 1.7%, respectively; P
=.05) at 3 years.
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