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Is there a therapeutic benefit of complete lymph node dissection in melanoma patients with low tumor burden in the sentinel node?

Satzger, Imkea; Meier, Andrea; Zapf, Antoniab; Niebuhr, Margaretea; Kapp, Alexandera; Gutzmer, Ralfa

doi: 10.1097/CMR.0000000000000081
ORIGINAL ARTICLES: Clinical research

In the case of a positive sentinel lymph node (SLN), melanoma patients are recommended to proceed to complete lymph node dissection (CLND). However, CLND for SLN-positive patients – especially with minimal tumor burden in SLN – is becoming more controversial. We analyzed the clinical course of 305 SLN-positive patients with a mean follow-up of 51.1 months by Kaplan–Meier analyses. Overall, 58/305 (17%) patients did not undergo CLND. These were compared with a matched selection of 58 comparable patients who underwent CLND. Moreover, 106/305 patients with minimal tumor burden in SLN (<0.1 mm diameter of the largest tumor deposit) were analyzed separately. Of these 106 patients, 34 did not undergo CLND, whereas 72/106 patients were treated by CLND. In the matched groups, the CLND group and the non-CLND group did not differ significantly with respect to clinical characteristics, characteristics of the primary melanoma, and histopathological parameters of SLN. There were no differences in recurrence-free survival (P=0.765) and overall survival (P=0.844). The total number of regional lymph node metastases and time to regional lymph node metastases were not significantly higher for non-CLND patients. The subgroup of patients with minimal tumor burden in SLN also did not benefit significantly from CLND. In our analyses from a single German center, we could not find any evidence for a therapeutic survival benefit for CLND after positive SLN. However, future prospective randomized trials should confirm these data.

aDepartment of Dermatology and Allergy, Hannover Medical School, Hannover

bInstitute for Biostatistics, Universitätsmedizin Göttingen, Göttingen, Germany

Correspondence to Imke Satzger, MD, Skin Cancer Centre Hannover, Department of Dermatology and Allergy, Hannover Medical School, Carl Neuberg Str. 1, D-30625 Hannover, Germany Tel: +49 511 532 0; fax: +49 511 532 18850; e-mail:

Received October 9, 2013

Accepted March 25, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins