Complete lymph node dissection for sentinel node-positive melanoma: Assessment of practice patterns in the United States

Karl Y Bilimoria, Charles M. Balch, David Jason Bentrem, Mark S. Talamonti, Clifford Y. Ko, Julie R. Lange, David P. Winchester, Jeffrey D Wayne

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110 Scopus citations

Abstract

Background: Currently, complete lymph node dissection (CLND) is recommended after identification of a metastatic lymph node by sentinel lymph node biopsy (SLNB). Guidelines suggest that CLND should be performed as a separate procedure, and a sufficient number of nodes should be examined. Our objective was to examine the utilization, timing, and adequacy of CLND for melanoma in the United States. Methods: From the National Cancer Data Base, patients diagnosed with stage I to III melanoma during 2004-2005 were identified. Multiple logistic regression was used to assess factors associated with CLND utilization, timing (separate operation from SLNB), and adequacy (examination of ≥10 nodes). Results: Of the 44,548 patients identified, 47.5% were pathologic stage IA, 23.8% stage IB, 14.1% stage II, and 14.6% stage III. Of the 17% (2942 of 17,524) with nodal metastases on SLNB, only 50% underwent a CLND. Patients were significantly less likely to undergo a CLND after SLNB if >75 years old or had lower extremity melanomas. Of the patients who underwent a CLND, only 42% underwent the CLND at a separate procedure after the SLNB. Of those who underwent a CLND, 69.2% had ≥10 nodes examined. Patients were significantly less likely to have ≥10 nodes examined if they were >75 years old or had lower extremity melanomas. Patients treated at NCCN/NCI-designated centers were significantly more likely to undergo nodal evaluation in concordance with established guidelines. Conclusions: Only half of patients with sentinel node-positive melanoma underwent CLND. Quality surveillance measures are needed to monitor, standardize, and improve the care of patients with malignant melanoma.

Original languageEnglish (US)
Pages (from-to)1566-1576
Number of pages11
JournalAnnals of surgical oncology
Volume15
Issue number6
DOIs
Publication statusPublished - Jun 1 2008

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Keywords

  • Completion lymph node dissection
  • Lymph node
  • Melanoma
  • Sentinel lymph node biopsy
  • Skin neoplasm
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Oncology

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