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VIDEO: Decision to undergo lymph node dissection remains ‘complicated’
NEW YORK — Vernon K. Sondak, MD, chair of the department of cutaneous oncology at Moffitt Cancer Center and a HemOnc Today Editorial Board member, discussed the role of completion lymph node dissection in patients with sentinel lymph–node positive melanoma at the HemOnc Today Melanoma and Cutaneous Malignancies meeting.
The ASCO/Society of Surgical Oncology joint guidelines on sentinel lymph node biopsy recommend completion lymph node dissection (CLND) for any positive node. Further, evidenced-based guidelines from the National Comprehensive Cancer Network state CLND should be discussed and offered for patients with stage III, lymph node–positive disease. However, it remains a complicated disease, Sondak said.
“For surgeons, it’s becoming an increasingly complicated and difficult discussion,” Sondak said. “For our patients, it’s become an increasingly uncertain and unsettling decision-making process.”
CLND is performed to gain regional control of the nodal basin with slightly lower morbidity than waiting for nodal recurrence to occur, to improve staging, and because nodal dissection is required to be considered for most contemporary clinical trials, Sondak said.
There are few studies that address whether dissection is useful. However, recently, a German study showed that after 3 years there was no difference in overall or distant, metastatic survival among patients with sentinel lymph–node positive melanoma who did or did not undergo dissection.
“If it doesn’t improve survival compared to watching and waiting and using ultrasound surveillance, I think many patients will be thinking of a nonoperative approach,” Sondak said, adding that first results from the randomized prospective MSLT II clinical trial are expected soon.
“It remains a complicated disease, but it is definitely a place where we will get new and additional information really soon.” – by Melinda Stevens
Disclosure: Sondak reports no relevant financial disclosures.