Does very early timing of lymph node surgery after resection of the primary tumour improve the clinical outcome of patients with melanoma?

Abstract

Background In patients with cutaneous melanoma (CM), the time span between resection of the primary tumour and sentinel lymph node biopsy (SLNB) as well as the subsequent interval between SLNB and complete lymph node dissection (CLND) varies greatly. Aim To determine whether very early timing of SLNB after resection of the primary tumour, or timing of CLND after SLNB affect the clinical outcome of patients with CM, compared with longer time intervals. Methods We compared the time spans between complete resection of the primary tumour and SLNB, and the interval between SLNB and CLND in a cohort of 896 patients with melanoma who had undergone SLNB. An interval between primary resection and SLNB or between SLNB and CLND of up to 7 days was classified as very early (VE‐SLNB and VE‐CLND, respectively). This time span was compared with intervals of > 7 days. Univariate and multivariate statistics were performed. Results VE‐SLNB was significantly associated with the presence of micrometastases. However, this was probably due to tumour thickness being significantly higher in patients with VE‐SLNB compared with patients with later SLNB. Importantly, VE‐SLNB was not significantly associated with disease relapse and VE‐CLND was not associated with melanoma‐specific death. Conclusions VE‐SLNB and VE‐CLND neither improved nor worsened the clinical outcome of patients. Thus, timing of SLNB and CLND has no influence on the overall clinical outcome of patients with melanoma. Our findings support the rational planning of lymph node surgery after resection of the primary tumour and provide help for effective patient counselling.

Timing of sentinel node biopsy independently predicts disease-free and overall survival in clinical stage I-II melanoma patients: A multicentre study of the Italian Melanoma Intergroup (IMI)

“…The results of the present study should be considered in the context of the current literature. To date, the impact of a longer time interval until SNB on DFS and OS has been reported in 11 studies [ [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] ], which included patients with negative and/or positive SN ( Table 4 ). The results so far reported are conflicting because of heterogeneity in patients' characteristics, number of patients included according to the SN status, the time interval to SNB which varies from 7 to 59 days and finally, the median follow-up.…”

“…Propensity score matching] HR [Early versus delayed] 1.77, 95%CI 1.11–2.83 [OS calculated from primary excision. Propensity score matching] Richtig [ 16 ] SN+: 121 43 42 months Not reported Not reported Gambichler [ 17 ] SN−: 667 SN+: 229 7 Not specified Not reported] Not reported Oude Ophuis [ 18 ] SN+:1015 47 36 months Not reported HR [1 day increase] 1.0, 95%CI 0.99–1.01 Parrett [ 19 ] SN−: 414 SN+: 78 40 11.7 years HR [Delayed versus early] 0.91, 95%CI 0.64–1.28 HR [Delayed versus early] 0.91, 95%CI 0.67–1.23 [MSS ] MSS, melanoma-specific survival; SN, sentinel lymph node; SN−, negative sentinel lymph node; SN+, positive sentinel lymph node; SNB, sentinel lymph node biopsy; DFS, disease-free survival; OS, overall survival; HR, hazard ratio; 95%CI, 95% confidence interval. …”

“…With regards to SN-negative cohorts, the results are still conflicting. In seven studies, the interval between primary melanoma excision and SNB was not associated with DFS and/or OS [ [9] , [10] , [11] , [12] , 14 , 17 , 19 ]. More recently, Tejera-Vaquerizo et al.…”

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

“…SLNB and CLND were performed in accordance with previous guidelines [1]. As in our previous study [11,12], macro-metastases in regional lymph nodes and distant metastatic disease were checked by physical examination and staging procedures, including ultrasound, computed tomography, and magnetic resonance imaging [1]. Based on previous clinical practice, patients with micrometastases in the SLN usually received CLND.…”