![]() Although slightly more patients have cancer return in the lymph nodes with this strategy, typically, it can be removed with delayed surgery. The authors studied adoption and real-world outcomes of ultrasound monitoring in over 1000 patients treated at 21 centers worldwide, finding that most patients now have ultrasounds instead of surgery. At initial assessment, real-world outcomes align with randomized trial findings, including in adjuvant therapy recipients.įor patients with melanoma of the skin and microscopic spread to lymph nodes, monitoring with ultrasound is an alternative to surgically removing the remaining lymph nodes. DSS and DMFS did not differ by nodal management or adjuvant treatment.Īctive surveillance has been adopted for most SLN-positive patients. On risk-adjusted multivariable analyses, CLND was associated with improved isolated nodal RFS (hazard ratio, 0.36 95% CI, 0.15-0.88), but not all-site RFS (HR, 0.68 95% CI, 0.45-1.02). In patients who received adjuvant treatment without undergoing prior CLND, all isolated nodal recurrences were resectable. Sixty-eight patients had an isolated nodal recurrence (surveillance, 6% CLND, 4%). ![]() After a median follow-up of 11 months, 220 patients developed recurrent disease (surveillance, 19% CLND, 22%), and 24 died of melanoma (surveillance, 2% CLND, 4%). Four hundred thirty-nine patients received adjuvant therapy (surveillance, 38% CLND, 39%), with the majority (83%) receiving anti-PD-1 immunotherapy. In total, 965 patients (84%) received active surveillance, 189 (16%) underwent CLND. In a retrospective cohort of SLN-positive adults treated at 21 institutions in Australia, Europe, and the United States from June 2017 to November 2019, the authors evaluated the impact of active surveillance and adjuvant therapy on all-site recurrence-free survival (RFS), isolated nodal RFS, distant metastasis-free survival (DMFS), and DSS using Kaplan-Meier curves and Cox proportional hazard models.Īmong 6347 SLN biopsies, 1154 (18%) were positive and had initial negative distant staging. Adoption and outcomes of active surveillance in clinical practice and in adjuvant therapy recipients are unknown. 22 Department of Surgical Oncology, University Medical Center, Groningen, the Netherlands.įor patients with sentinel lymph node (SLN)-positive cutaneous melanoma, the Second Multicenter Selective Lymphadenectomy trial demonstrated equivalent disease-specific survival (DSS) with active surveillance using nodal ultrasound versus completion lymph node dissection (CLND).21 Department of Surgery, University of Minnesota, Minneapolis, Minnesota.20 Department of Surgery, Duke University, Durham, North Carolina.19 Surgery Clinic, North Estonia Medical Center Foundation, Tallinn, Estonia.18 Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia.17 Department of Surgery, NYU Langone Health, New York, New York.16 Department of Surgery, Sahlgrenska Center for Cancer Research, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.15 Department of Surgery, Emory University, Atlanta, Georgia.14 Department of Surgery, University of Tennessee, Memphis, Tennessee.13 Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.12 Department of Surgery, Oregon Health & Science University, Portland, Oregon.11 Department of Plastic Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom.10 Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.9 Department of Surgery, University of North Carolina, Chapel Hill, North Carolina.8 Division of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.7 Division of Cancer Surgery, Peter MacCallum Cancer Center, Melbourne, Australia.6 Department of Surgery, Department of Oncology, Mayo Clinic, Rochester, Minnesota.5 Department of Surgery, Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.4 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.3 Department of Surgery, University of Michigan, Ann Arbor, Michigan.2 Department of Oncologic Sciences, University of South Florida Morsani School of Medicine, Tampa, Florida.Lee Moffitt Cancer Center, Tampa, Florida. 1 Department of Cutaneous Oncology, H. ![]()
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