Dissecting the Need for Adjuvant Therapy in Patients With Early-Stage Melanoma With Micrometastases

Abstract

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Reply to A. Mangla and E. Hindié

“…Accordingly, we share some of Dr Hindié's 2 concerns regarding the use of SNB in the pT1b cohort and refer her to our recent parallel publication, which extensively analyzes this important topic. 4 We also agree with Dr Mangla 1 that current criteria for consideration of adjuvant therapy 5 are based mainly on interim outcomes of clinical trials 6,7 whose entry criteria used AJCC-7th edition staging and included routine completion lymphadenectomy after a positive SNB, a clinical practice no longer routinely undertaken. 8 Moreover, the primary end point of most randomized adjuvant therapy trials was recurrence-free survival, rather than overall survival or DSS—which are typically the focus of most prognostic studies such as ours.…”

“…We read with interest the correspondence from Dr Mangla 1 and Dr Hindié 2 concerning our recent study, 3 which stratified patients with American Joint Committee on Cancer (AJCC)–8th edition stage IIIA melanoma into low-risk and high-risk subgroups on the basis of the sentinel node (SN) maximum tumor deposit size (MTDS). We found that MTDS ≥ 0.3 mm represented high-risk micrometastatic disease, whereas outcomes for patients with MTDS below that threshold were like those of SN biopsy (SNB)–negative patients.…”

“…Finally, to directly address the query by Dr Mangla, 1 the aim of our analysis was not to determine which patients with AJCC IIIA micrometastatic disease should be referred for adjuvant therapy. Rather, the aim was to determine which patients with AJCC IIIA melanoma were at lower or higher risk of death from their disease, on the basis of modern surgical practice and according to the more intuitive biomarkers of MTDS and ENE.…”

A Rare Case of Acral Lentiginous Melanoma

“…Acral lentiginous melanoma has a higher percentage of positivity for KIT mutations, and drugs targeting KIT mutations like imatinib have been studied in metastatic settings. Their role in adjuvant treatment has not been established yet [ 12 , 13 ].…”