Regional control after precision lymph node dissection for clinically evident melanoma metastasis

Introduction Completion lymph node dissection (CLND) for microscopic lymph node metastases has been replaced by observation; however, CLND is standard for clinically detectable nodal metastases (cLN). CLND has high morbidity, which may be reduced by excision of only the cLN (precision lymph node dis...

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Published in:Journal of surgical oncology 2023-01, Vol.127 (1), p.140-147
Main Authors: Lynch, Kevin T., Hu, Yinin, Farrow, Norma E., Song, Yun, Meneveau, Max O., Kwak, Minyoung, Lowe, Michael C., Bartlett, Edmund K., Beasley, Georgia M., Karakousis, Giorgos C., Slingluff, Craig L.
Format: Article
Language:English
Subjects:
Dissection
Humans
Lymph Node Excision
Lymph Nodes - pathology
Lymphatic Metastasis - pathology
Lymphatic system
Melanoma
Melanoma - pathology
Metastasis
nodal metastases
Patients
precision nodal dissection
Retrospective Studies
Sentinel Lymph Node Biopsy
Skin Neoplasms - pathology
Skin Neoplasms - surgery
Syndrome
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Summary:Introduction Completion lymph node dissection (CLND) for microscopic lymph node metastases has been replaced by observation; however, CLND is standard for clinically detectable nodal metastases (cLN). CLND has high morbidity, which may be reduced by excision of only the cLN (precision lymph node dissection [PLND]). We hypothesized that same‐basin recurrence risk would be low after PLND. Methods Retrospective review at four tertiary care hospitals identified patients who underwent PLND. The primary outcome was 3‐year cumulative incidence of isolated same‐basin recurrence. Results Twenty‐one patients underwent PLND for cLN without synchronous distant metastases. Reasons for forgoing CLND included patient preference (n = 11), comorbidities (n = 5), imaging indeterminate for distant metastases (n = 2), partial response to checkpoint blockade (n = 1), or not reported (n = 2). A median of 2 nodes (range: 1–6) were resected at PLND, and 68% contained melanoma. Recurrence was observed in 33% overall. Only 1 patient (5%) developed an isolated same‐basin recurrence. Cumulative incidences at 3 years were 5.0%, 17.3%, and 49.7% for isolated same‐basin recurrence, any same‐basin recurrence, and any recurrence, respectively. Complications from PLND were reported in 1 patient (5%). Conclusions These pilot data suggest that PLND may provide adequate regional disease control with less morbidity than CLND. These data justify prospective evaluation of PLND in select patients.
ISSN:0022-4790
1096-9098
1096-9098
DOI:10.1002/jso.27100