Current management of melanoma patients with nodal metastases

Abstract

The management of melanoma patients with nodal metastases has undergone dramatic changes over the last decade. In the past, the standard of care for patients with a positive sentinel lymph node biopsy (SLNB) was a completion lymph node dissection (CLND), while patients with palpable macroscopic nodal disease underwent a therapeutic lymphadenectomy in cases with no evidence of systemic spread. However, studies have shown that SLN metastases present as a spectrum of disease, with certain SLN-based factors being prognostic of and correlated with outcomes. Furthermore, the results of key clinical trials demonstrate that CLND provides no survival benefit over nodal observation in positive SLN patients, while other clinical trials have shown that adjuvant immune checkpoint inhibitor therapy or targeted therapy after CLND is associated with a recurrence-free survival benefit. Given the efficacy of these systemic therapies in the adjuvant setting, these agents are now being evaluated and utilized as neoadjuvant treatments in patients with regionally-localized or resectable metastatic melanoma. Multiple options now exist to treat melanoma patients with nodal disease, and determining the best treatment course for a particular case requires an in-depth knowledge of current data and an informed discussion with the patient. This review will provide an overview of the various options for treating melanoma patients with nodal metastases and will discuss the data that supported the development of these treatment options.

Waiving Subsequent Complete Lymph Node Dissection in Melanoma Patients with Positive Sentinel Lymph Node Does Not Result in Worse Outcome on 20-Year Analysis

“…But only patients with micrometastases beyond the SLN-which only applies to about 20% of SLN-positive cases-benefit from CLND. In contrast, patients with additional non-SLN micrometastases have worse survival rates, and thus having the knowledge about the status of non-SLN tumor load potentially provides prognostic information [14][15][16][17]. Our data confirm the relatively low number of non-SLN micrometastases detected on CLND in 25.8% of cases.…”

Live imaging of neolymphangiogenesis identifies acute antimetastatic roles of dsRNA mimics

“…To this end, xenografts of human mCherry‐labeled SK‐Mel‐147 melanoma cells were implanted subcutaneously. Primary lesions were excised when Vegfr3 Luc was detectable in a systemic manner, at time points where micrometastases confirmed histopathologically in parallel studies in the lymph nodes (see Fig EV5 ) mimicking patients with melanomas at stage III that would be considered for adjuvant therapy (Han et al , 2021 ).…”

Psychosocial well-being and mental adjustment of patients with stage III melanoma in the re-entry phase: a scoping review

“…[1] Melanoma has traditionally been regarded as an inevitably fatal disease when diagnosed at a late stage. However, options for adjuvant treatment have improved considerably since 2010, [2] leading to major improvements in overall survival [3] and prolonged progression-free survival of patients with metastatic disease (stage IV). [4] In recent years, patients with regional nodal metastases (stage III) have also become eligible for adjuvant therapy, resulting in an increase of relative disease-free survival rates from 18-38% [5] to 50%.…”