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. 2020 Dec;122(8):1778-1784.
doi: 10.1002/jso.26200. Epub 2020 Sep 6.

Management of the positive sentinel lymph node in the post-MSLT-II era

Brooke C Bredbeck  1 , Eman Mubarak  1 , Daniela G Zubieta  1 , Rachael Tesorero  1 , Adam R Holmes  1 , Lesly A Dossett  1   2 , Kyle K VanKoevering  2   3 , Alison B Durham  2   4 , Tasha M Hughes  1   2
Affiliations

Management of the positive sentinel lymph node in the post-MSLT-II era

Brooke C Bredbeck et al. J Surg Oncol. 2020 Dec.

Abstract

Background and objectives: The publication of MSLT-II shifted recommendations for management of sentinel lymph node biopsy positive (SLNB+) melanoma to favor active surveillance. We examined trends in immediate completion lymph node dissection (CLND) following publication of MSLT-II.

Methods: Using a prospective melanoma database at a high-volume center, we identified a cohort of consecutive SLNB+ patients from July 2016 to April 2019. Patient and disease characteristics were analyzed with multivariate logistic regression to examine factors associated with CLND.

Results: Two hundred and thirty-five patients were included for analysis. CLND rates were 67%, 33%, and 26% for the year before, year after, and second-year following MSLT-II. Factors associated with undergoing CLND included primary located in the head and neck (59% vs 33%, P = .003 and odds ratio [OR], 5.22, P = .002) and higher sentinel node tumor burden (43% vs 10% for tumor burden ≥0.1 mm, P < .001 and OR, 8.64, P = .002).

Conclusions: Rates of CLND in SLNB+ melanoma decreased dramatically, albeit not uniformly, following MSLT-II. Factors that increased the likelihood of immediate CLND were primary tumor located in the head and neck and high sentinel node tumor burden. These groups were underrepresented in MSLT-II, suggesting that clinicians are wary of implementing active surveillance recommendations for patients perceived as higher risk.

Keywords: CLND; MSLT-II; SLNB; melanoma.

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Figures

FIGURE 1
FIGURE 1
Quarterly trends in immediate completion lymph node dissection rates relative to the publication of MSLT-II. Immediate completion lymph node dissection rates by quarter (Q, or 3 month periods) in the two years following publication of MSLT-II, here labeled as peri MSLT-II and post MSLT-II. There was a steep and persistent decrease in rates of CLND 3 months after publication, marking an inflection point at Q2 in the peri MSLT-II period
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