Therapeutic Value of Sentinel Lymph Node Biopsy in Patients With Melanoma: A Randomized Clinical Trial

doi:10.1001/jamasurg.2022.2055

. 2022 Sep 1;157(9):835-842.

doi: 10.1001/jamasurg.2022.2055.

Therapeutic Value of Sentinel Lymph Node Biopsy in Patients With Melanoma: A Randomized Clinical Trial

Multicenter Selective Lymphadenectomy Trials Study Group; Jessica S Crystal¹, John F Thompson², John Hyngstrom³, Corrado Caracò⁴, Jonathan S Zager⁵, Tiina Jahkola⁶, Tawnya L Bowles⁷, Elisabetta Pennacchioli⁸, Peter D Beitsch⁹, Harald J Hoekstra¹⁰, Marc Moncrieff¹¹, Christian Ingvar¹², Alexander van Akkooi¹³, Michael S Sabel¹⁴, Edward A Levine¹⁵, Doreen Agnese¹⁶, Michael Henderson¹⁷, Reinhard Dummer¹⁸, Rogerio I Neves^{19

20}, Carlo Riccardo Rossi²¹, John M Kane 3rd²², Steven Trocha²³, Frances Wright²⁴, David R Byrd²⁵, Maurice Matter²⁶, Eddy C Hsueh²⁷, Alastair MacKenzie-Ross²⁸, Mark Kelley²⁹, Patrick Terheyden³⁰, Tara L Huston³¹, Jeffrey D Wayne³², Heather Neuman³³, B Mark Smithers³⁴, Charlotte E Ariyan³⁵, Darius Desai³⁶, Jeffrey E Gershenwald³⁷, Shlomo Schneebaum³⁸, Anja Gesierich³⁹, Lisa K Jacobs⁴⁰, James M Lewis⁴¹, Kelly M McMasters⁴², Cristina O'Donoghue⁴³, Andre van der Westhuizen⁴⁴, Armando Sardi⁴⁵, Richard Barth⁴⁶, Robert Barone⁴⁷, J Greg McKinnon⁴⁸, Craig L Slingluff⁴⁹, Jeffrey M Farma⁵⁰, Erwin Schultz⁵¹, Randall P Scheri⁵², Sergi Vidal-Sicart⁵³, Manuel Molina⁵⁴, Alessandro A E Testori⁵⁵, Leland J Foshag⁵⁶, Lisa Van Kreuningen⁵⁷, He-Jing Wang⁵⁸, Myung-Shin Sim⁵⁹, Richard A Scolyer⁶⁰, David E Elashoff⁵⁸, Alistair J Cochran⁶¹, Mark B Faries⁶²

Affiliations

¹ Department of Surgery, University of Miami, Miami, Florida.
² Melanoma Institute Australia, The University of Sydney, Sydney, Australia.
³ Department of Surgery, University of Utah, Salt Lake City.
⁴ Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale," Napoli, Italy.
⁵ Departments of Cutaneous Oncology and Sarcoma, H. Lee Moffitt Cancer Center, Tampa, Florida.
⁶ Department of Plastic and Reconstructive Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
⁷ Department of Surgical Oncology, Intermountain Medical Center, Salt Lake City, Utah.
⁸ Division of Melanoma, Soft Tissue Sarcomas and Rare Tumors, European Institute of Oncology, Milano, Italy.
⁹ Dallas Surgical Group, Dallas, Texas.
¹⁰ Department of Surgery, University Hospital Groningen, Groningen, the Netherlands.
¹¹ Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom.
¹² Department of Surgery, Lund University, Lund, Sweden.
¹³ Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
¹⁴ Department of Surgery, University of Michigan, Ann Arbor.
¹⁵ Department of Surgical Oncology, Wake Forest University, Winston-Salem, North Carolina.
¹⁶ Department of Surgery, Ohio State University, Columbus.
¹⁷ Department of Surgery, University of Melbourne, Peter MacCallum Cancer Centre, Melbourne, Australia.
¹⁸ Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
¹⁹ Department of Surgery, Pennsylvania State University Milton S. Hershey Medical Center, Hershey.
²⁰ Now at Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
²¹ Melanoma and Sarcomas Unit, Veneto Institute of Oncology, Padua, Italy.
²² Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York.
²³ Department of Surgical Oncology, Prisma Health, Columbia, South Carolina.
²⁴ Department of Surgical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
²⁵ Department of Surgery, University of Washington, Seattle.
²⁶ Department of Surgery, Lausanne University Hospital, Lausanne, Switzerland.
²⁷ Department of Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri.
²⁸ Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
²⁹ Department of Surgery, Vanderbilt University, Nashville, Tennessee.
³⁰ Department of Dermatology, University of Lubeck, Lubeck, Germany.
³¹ Department of Surgery, Stony Brook University, Stony Brook, New York.
³² Department of Surgery, Northwestern University, Chicago, Illinois.
³³ Department of Surgery, University of Wisconsin at Madison.
³⁴ Department of Surgery, University of Queensland, Brisbane, Australia.
³⁵ Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
³⁶ Department of Surgery, Saint Luke's University Hospital, Bethlehem, Pennsylvania.
³⁷ Department of Surgical Oncology, MD Anderson Cancer Center, Houston, Texas.
³⁸ Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
³⁹ Department of Dermatology, University Hospital Wurzburg, Wurzburg, Germany.
⁴⁰ Department of Surgery, Johns Hopkins University, Baltimore, Maryland.
⁴¹ Department of Surgery, University of Tennessee Medical Center, Knoxville.
⁴² Department of Surgery, University of Louisville, Louisville, Tennessee.
⁴³ Department of Surgery, Rush University, Chicago, Illinois.
⁴⁴ Department of Medical Oncology, Calvary Mater Hospital, Waratah, Australia.
⁴⁵ Department of Surgical Oncology, Mercy Medical Center, Baltimore, Maryland.
⁴⁶ Department of Surgery, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire.
⁴⁷ Surgical Oncology, Sharp Hospital, San Diego, California.
⁴⁸ Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
⁴⁹ Department of Surgery, University of Virginia, Charlottesville.
⁵⁰ Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
⁵¹ Department of Dermatology, Nuremberg General Hospital, Paracelsus Medical Center, Nuremberg, Germany.
⁵² Department of Surgery, Duke University, Durham, North Carolina.
⁵³ Nuclear Medicine Department, Hospital Clinic Barcelona, Barcelona, Spain.
⁵⁴ Department of Surgery, Lakeland Regional Health, Lakeland, Florida.
⁵⁵ Department of Dermatology, Image Regenerative Clinic, Milano, Italy.
⁵⁶ Department of Surgical Oncology, John Wayne Cancer Institute, Santa Monica, California.
⁵⁷ Manager of Research Operations, Saint John's Cancer Institute, Santa Monica, California.
⁵⁸ Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, University of California, Los Angeles.
⁵⁹ Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles.
⁶⁰ Melanoma Institute Australia, Department of Medicine, University of Sydney, Sydney, Australia.
⁶¹ Department of Anatomic Pathology, David Geffen School of Medicine at UCLA, University of California, Los Angeles.
⁶² The Angeles Clinic and Research Institute, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.

PMID: 35921122
PMCID: PMC9475390
DOI: 10.1001/jamasurg.2022.2055

Therapeutic Value of Sentinel Lymph Node Biopsy in Patients With Melanoma: A Randomized Clinical Trial

Multicenter Selective Lymphadenectomy Trials Study Group et al. JAMA Surg. 2022.

. 2022 Sep 1;157(9):835-842.

doi: 10.1001/jamasurg.2022.2055.

Authors

Affiliations

¹ Department of Surgery, University of Miami, Miami, Florida.
² Melanoma Institute Australia, The University of Sydney, Sydney, Australia.
³ Department of Surgery, University of Utah, Salt Lake City.
⁴ Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale," Napoli, Italy.
⁵ Departments of Cutaneous Oncology and Sarcoma, H. Lee Moffitt Cancer Center, Tampa, Florida.
⁶ Department of Plastic and Reconstructive Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
⁷ Department of Surgical Oncology, Intermountain Medical Center, Salt Lake City, Utah.
⁸ Division of Melanoma, Soft Tissue Sarcomas and Rare Tumors, European Institute of Oncology, Milano, Italy.
⁹ Dallas Surgical Group, Dallas, Texas.
¹⁰ Department of Surgery, University Hospital Groningen, Groningen, the Netherlands.
¹¹ Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom.
¹² Department of Surgery, Lund University, Lund, Sweden.
¹³ Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
¹⁴ Department of Surgery, University of Michigan, Ann Arbor.
¹⁵ Department of Surgical Oncology, Wake Forest University, Winston-Salem, North Carolina.
¹⁶ Department of Surgery, Ohio State University, Columbus.
¹⁷ Department of Surgery, University of Melbourne, Peter MacCallum Cancer Centre, Melbourne, Australia.
¹⁸ Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
¹⁹ Department of Surgery, Pennsylvania State University Milton S. Hershey Medical Center, Hershey.
²⁰ Now at Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
²¹ Melanoma and Sarcomas Unit, Veneto Institute of Oncology, Padua, Italy.
²² Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York.
²³ Department of Surgical Oncology, Prisma Health, Columbia, South Carolina.
²⁴ Department of Surgical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
²⁵ Department of Surgery, University of Washington, Seattle.
²⁶ Department of Surgery, Lausanne University Hospital, Lausanne, Switzerland.
²⁷ Department of Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri.
²⁸ Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
²⁹ Department of Surgery, Vanderbilt University, Nashville, Tennessee.
³⁰ Department of Dermatology, University of Lubeck, Lubeck, Germany.
³¹ Department of Surgery, Stony Brook University, Stony Brook, New York.
³² Department of Surgery, Northwestern University, Chicago, Illinois.
³³ Department of Surgery, University of Wisconsin at Madison.
³⁴ Department of Surgery, University of Queensland, Brisbane, Australia.
³⁵ Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
³⁶ Department of Surgery, Saint Luke's University Hospital, Bethlehem, Pennsylvania.
³⁷ Department of Surgical Oncology, MD Anderson Cancer Center, Houston, Texas.
³⁸ Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
³⁹ Department of Dermatology, University Hospital Wurzburg, Wurzburg, Germany.
⁴⁰ Department of Surgery, Johns Hopkins University, Baltimore, Maryland.
⁴¹ Department of Surgery, University of Tennessee Medical Center, Knoxville.
⁴² Department of Surgery, University of Louisville, Louisville, Tennessee.
⁴³ Department of Surgery, Rush University, Chicago, Illinois.
⁴⁴ Department of Medical Oncology, Calvary Mater Hospital, Waratah, Australia.
⁴⁵ Department of Surgical Oncology, Mercy Medical Center, Baltimore, Maryland.
⁴⁶ Department of Surgery, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire.
⁴⁷ Surgical Oncology, Sharp Hospital, San Diego, California.
⁴⁸ Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
⁴⁹ Department of Surgery, University of Virginia, Charlottesville.
⁵⁰ Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
⁵¹ Department of Dermatology, Nuremberg General Hospital, Paracelsus Medical Center, Nuremberg, Germany.
⁵² Department of Surgery, Duke University, Durham, North Carolina.
⁵³ Nuclear Medicine Department, Hospital Clinic Barcelona, Barcelona, Spain.
⁵⁴ Department of Surgery, Lakeland Regional Health, Lakeland, Florida.
⁵⁵ Department of Dermatology, Image Regenerative Clinic, Milano, Italy.
⁵⁶ Department of Surgical Oncology, John Wayne Cancer Institute, Santa Monica, California.
⁵⁷ Manager of Research Operations, Saint John's Cancer Institute, Santa Monica, California.
⁵⁸ Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, University of California, Los Angeles.
⁵⁹ Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles.
⁶⁰ Melanoma Institute Australia, Department of Medicine, University of Sydney, Sydney, Australia.
⁶¹ Department of Anatomic Pathology, David Geffen School of Medicine at UCLA, University of California, Los Angeles.
⁶² The Angeles Clinic and Research Institute, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.

PMID: 35921122
PMCID: PMC9475390
DOI: 10.1001/jamasurg.2022.2055

Erratum in

Errors in Byline.
[No authors listed] [No authors listed] JAMA Surg. 2022 Sep 1;157(9):859. doi: 10.1001/jamasurg.2022.4558. JAMA Surg. 2022. PMID: 36102914 Free PMC article. No abstract available.

Abstract

Importance: Sentinel lymph node (SLN) biopsy is a standard staging procedure for cutaneous melanoma. Regional disease control is a clinically important therapeutic goal of surgical intervention, including nodal surgery.

Objective: To determine how frequently SLN biopsy without completion lymph node dissection (CLND) results in long-term regional nodal disease control in patients with SLN metastases.

Design, setting, and participants: The second Multicenter Selective Lymphadenectomy Trial (MSLT-II), a prospective multicenter randomized clinical trial, randomized participants with SLN metastases to either CLND or nodal observation. The current analysis examines observation patients with regard to regional nodal recurrence. Trial patients were aged 18 to 75 years with melanoma metastatic to SLN(s). Data were collected from December 2004 to April 2019, and data were analyzed from July 2020 to January 2022.

Interventions: Nodal observation with ultrasonography rather than CLND.

Main outcomes and measures: In-basin nodal recurrence.

Results: Of 823 included patients, 479 (58.2%) were male, and the mean (SD) age was 52.8 (13.8) years. Among 855 observed basins, at 10 years, 80.2% (actuarial; 95% CI, 77-83) of basins were free of nodal recurrence. By univariable analysis, freedom from regional nodal recurrence was associated with age younger than 50 years (hazard ratio [HR], 0.49; 95% CI, 0.34-0.70; P < .001), nonulcerated melanoma (HR, 0.36; 95% CI, 0.36-0.49; P < .001), thinner primary melanoma (less than 1.5 mm; HR, 0.46; 95% CI, 0.27-0.78; P = .004), axillary basin (HR, 0.61; 95% CI, 0.44-0.86; P = .005), fewer positive SLNs (1 vs 3 or more; HR, 0.32; 95% CI, 0.14-0.75; P = .008), and SLN tumor burden (measured by diameter less than 1 mm [HR, 0.39; 95% CI, 0.26-0.60; P = .001] or less than 5% area [HR, 0.36; 95% CI, 0.24-0.54; P < .001]). By multivariable analysis, younger age (HR, 0.57; 95% CI, 0.39-0.84; P = .004), thinner primary melanoma (HR, 0.40; 95% CI, 0.22-0.70; P = .002), axillary basin (HR, 0.55; 95% CI, 0.31-0.96; P = .03), SLN metastasis diameter less than 1 mm (HR, 0.52; 95% CI, 0.33-0.81; P = .007), and area less than 5% (HR, 0.58; 95% CI, 0.38-0.88; P = .01) were associated with basin control. When looking at the identified risk factors of age (50 years or older), ulceration, Breslow thickness greater than 3.5 mm, nonaxillary basin, and tumor burden of maximum diameter of 1 mm or greater and/or metastasis area of 5% or greater and excluding missing value cases, basin disease-free rates at 5 years were 96% (95% CI, 88-100) for patients with 0 risk factors, 89% (95% CI, 82-96) for 1 risk factor, 86% (95% CI, 80-93) for 2 risk factors, 80% (95% CI, 71-89) for 3 risk factors, 61% (95% CI, 48-74) for 4 risk factors, and 54% (95% CI, 36-72) for 5 or 6 risk factors.

Conclusions and relevance: This randomized clinical trial was the largest prospective evaluation of long-term regional basin control in patients with melanoma who had nodal observation after removal of a positive SLN. SLN biopsy without CLND cleared disease in the affected nodal basin in most patients, even those with multiple risk factors for in-basin recurrence. In addition to its well-validated value in staging, SLN biopsy may also be regarded as therapeutic in some patients.

Trial registration: ClinicalTrials.gov Identifier: NCT00297895.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Thompson has received grants from the Australian National Health and Medical Research Council during the conduct of the study as well as personal fees from Bristol Myers Squibb, Merck Sharp & Dohme, GlaxoSmithKline, and Provectus and nonfinancial support from Novartis outside the submitted work. Dr Hyngstrom has received personal fees from Nektar/Bristol Myers Squibb outside the submitted work. Dr Zager has received personal fees for Castle Biosciences, Merck, Novartis, Philogen, and Delcath Systems outside the submitted work. Dr Bowles has received grants from Genentech and is principal investigator of clinical trials conducted by Genentech, Amgen, and Replimune outside the submitted work. Dr van Akkooi has received grants and personal fees from Amgen, Bristol Myers Squibb, Novartis, Merck Sharp & Dohme, Merck-Pfizer, Pierre Fabre, Sanofi, Sirius Medical, and 4SC paid to his institution outside the submitted work. Dr Dummer has received personal fees from Novartis, Merck Sharp & Dohme, Bristol Myers Squibb, Roche, Amgen, Takeda, Pierre Fabre, Sun Pharma, Sanofi, Catalym, Second Genome, Regeneron, Alligator, T3 Pharma, MaxiVAX SA, Pfizer, and touchIME outside the submitted work. Dr Neves reports personal fees from Novartis Advisory Board, personal fees from Castle Biosciences Advisory Board, and personal fees from Sanofi-Genzyme Advisory Board outside the submitted work. Dr Hsueh has received personal fees from Castle Biosciences outside the submitted work. Dr MacKenzie-Ross has received fees from John Wayne Cancer Institute paid to his institution during the conduct of the study. Dr Kelley has received fees from John Wayne Cancer Institute paid to his institution during the conduct of the study. Dr Terheyden has received personal fees from Bristol Myers Squibb, Novartis, Merck Sharp & Dohme, Pierre Fabre, CureVac, Merck Serono, Sanofi, Roche, Kyowa Kirin, Biofrontera, and Almirall outside the submitted work. Dr Gershenwald has received personal fees from Merck, Syndax, Regeneron, and Bristol Myers Squibb outside the submitted work. Dr Gesierich has received personal fees from Amgen, Bristol Myers Squibb, Merck Sharp & Dohme, Novartis, Pierre Fabre, Pfizer, Roche, and Sanofi outside the submitted work. Dr Sardi has received grants from the John Wayne Cancer Institute during the conduct of the study. Dr Barth has received grants from the National Institutes of Health during the conduct of the study. Dr Slingluff has received grants from Celldex and Merck; nonfinancial support from Theraclion; personal fees from Curevac paid to his institution; and fees from Polynoma for serving as principal investigator of a multicenter trial paid to his institution; and has a patent for peptides for use in melanoma vaccines licensed. Dr Van Kreuningen has received grants from John Wayne Cancer Institute during the conduct of the study. Dr Scolyer has received grants from the National Health and Medical Research Council of Australia during the conduct of the study as well as personal fees from Qbiotics, Novartis, Merck Sharp & Dohme, NeraCare, Amgen, Bristol Myers Squibb, Myriad Genetics, and GlaxoSmithKline outside the submitted work. Dr Cochran has received grants from National Cancer Institute during the conduct of the study. Dr Faries has received grants from the National Institutes of Health during the conduct of the study as well as personal fees from Merck, Bristol Myers Squibb, Novartis, Array Bioscience, Sanofi, and Nektar outside the submitted work. No other disclosures were reported.

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Comment in

Prognostic or Therapeutic-The Role of Sentinel Lymph Node Biopsy in Contemporary Practice.
Rhodin KE, Beasley GM, Tyler DS. Rhodin KE, et al. JAMA Surg. 2022 Sep 1;157(9):843. doi: 10.1001/jamasurg.2022.2054. JAMA Surg. 2022. PMID: 35921120 No abstract available.

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References

1. Morton DL, Wen DR, Wong JH, et al. . Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127(4):392-399. doi:10.1001/archsurg.1992.01420040034005 - DOI - PubMed
1. Dessureault S, Soong SJ, Ross MI, et al. ; American Joint Committee on Cancer (AJCC) Melanoma Staging Committee . Improved staging of node-negative patients with intermediate to thick melanomas (>1 mm) with the use of lymphatic mapping and sentinel lymph node biopsy. Ann Surg Oncol. 2001;8(10):766-770. doi:10.1007/s10434-001-0766-1 - DOI - PubMed
1. Morton DL, Thompson JF, Cochran AJ, et al. ; MSLT Group . Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med. 2014;370(7):599-609. doi:10.1056/NEJMoa1310460 - DOI - PMC - PubMed
1. McMasters KM, Egger ME, Edwards MJ, et al. . Final results of the Sunbelt Melanoma Trial: a multi-institutional prospective randomized phase III study evaluating the role of adjuvant high-dose interferon alfa-2b and completion lymph node dissection for patients staged by sentinel lymph node biopsy. J Clin Oncol. 2016;34(10):1079-1086. doi:10.1200/JCO.2015.63.3776 - DOI - PMC - PubMed
1. Faries MB, Thompson JF, Cochran AJ, et al. . Completion dissection or observation for sentinel-node metastasis in melanoma. N Engl J Med. 2017;376(23):2211-2222. doi:10.1056/NEJMoa1613210 - DOI - PMC - PubMed

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[1] Morton DL, Wen DR, Wong JH, et al. . Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127(4):392-399. doi:10.1001/archsurg.1992.01420040034005 - DOI - PubMed

[2] Morton DL, Wen DR, Wong JH, et al. . Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127(4):392-399. doi:10.1001/archsurg.1992.01420040034005 - DOI - PubMed

[3] Dessureault S, Soong SJ, Ross MI, et al. ; American Joint Committee on Cancer (AJCC) Melanoma Staging Committee . Improved staging of node-negative patients with intermediate to thick melanomas (>1 mm) with the use of lymphatic mapping and sentinel lymph node biopsy. Ann Surg Oncol. 2001;8(10):766-770. doi:10.1007/s10434-001-0766-1 - DOI - PubMed

[4] Dessureault S, Soong SJ, Ross MI, et al. ; American Joint Committee on Cancer (AJCC) Melanoma Staging Committee . Improved staging of node-negative patients with intermediate to thick melanomas (>1 mm) with the use of lymphatic mapping and sentinel lymph node biopsy. Ann Surg Oncol. 2001;8(10):766-770. doi:10.1007/s10434-001-0766-1 - DOI - PubMed

[5] Morton DL, Thompson JF, Cochran AJ, et al. ; MSLT Group . Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med. 2014;370(7):599-609. doi:10.1056/NEJMoa1310460 - DOI - PMC - PubMed

[6] Morton DL, Thompson JF, Cochran AJ, et al. ; MSLT Group . Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med. 2014;370(7):599-609. doi:10.1056/NEJMoa1310460 - DOI - PMC - PubMed

[7] McMasters KM, Egger ME, Edwards MJ, et al. . Final results of the Sunbelt Melanoma Trial: a multi-institutional prospective randomized phase III study evaluating the role of adjuvant high-dose interferon alfa-2b and completion lymph node dissection for patients staged by sentinel lymph node biopsy. J Clin Oncol. 2016;34(10):1079-1086. doi:10.1200/JCO.2015.63.3776 - DOI - PMC - PubMed

[8] McMasters KM, Egger ME, Edwards MJ, et al. . Final results of the Sunbelt Melanoma Trial: a multi-institutional prospective randomized phase III study evaluating the role of adjuvant high-dose interferon alfa-2b and completion lymph node dissection for patients staged by sentinel lymph node biopsy. J Clin Oncol. 2016;34(10):1079-1086. doi:10.1200/JCO.2015.63.3776 - DOI - PMC - PubMed

[9] Faries MB, Thompson JF, Cochran AJ, et al. . Completion dissection or observation for sentinel-node metastasis in melanoma. N Engl J Med. 2017;376(23):2211-2222. doi:10.1056/NEJMoa1613210 - DOI - PMC - PubMed

[10] Faries MB, Thompson JF, Cochran AJ, et al. . Completion dissection or observation for sentinel-node metastasis in melanoma. N Engl J Med. 2017;376(23):2211-2222. doi:10.1056/NEJMoa1613210 - DOI - PMC - PubMed

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Therapeutic Value of Sentinel Lymph Node Biopsy in Patients With Melanoma: A Randomized Clinical Trial

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Therapeutic Value of Sentinel Lymph Node Biopsy in Patients With Melanoma: A Randomized Clinical Trial

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