Interim results of the Multicenter Selective Lymphadenectomy Trial (MSLT-I) in clinical stage I melanoma

Morton, Donald L.; Je, Thompson; Aj, Cochran; Essner, Richard; Elashoff, Robert

doi:10.1200/jco.2005.23.16_suppl.7500

Cited by 55 publications

(41 citation statements)

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“…A very recent third interim analysis of a worldwide randomized trial, the Mslt-1 trial, on SNB shows that melanoma patients who had wide excision followed by SLND (n = 1204) had a survival similar to patients where a watch-and-wait policy had been followed (n = 797), with CLND in case of pathological lymph node development [3]. In this study, the disease free survival was superior after SNB [4].…”

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confidence: 78%

What is the impact of sentinel node biopsy in the management of cancer?

2005

Annals of Oncology

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confidence: 78%

What is the impact of sentinel node biopsy in the management of cancer?

2005

Annals of Oncology

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“…Preliminary data showed a significantly (P = 0.01) higher 5-year disease-free survival (78%) for patients undergoing lymphatic mapping and sentinel node biopsy compared with those treated by wide excision alone (73%). There is no difference in overall survival between the two treatment groups, yet tumor status of the sentinel node remained the strongest predictor of outcome in these patients (9).…”

Section: Development Of Lymphatic Mapping and Sentinel Node Biopsymentioning

confidence: 99%

Sentinel Lymph Node Biopsy and Melanoma Biology

Essner

2006

Clinical Cancer Research

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Minimally invasive intraoperative lymphatic mapping and sentinel node biopsy has become the standard approach for staging the regional lymph nodes for early-stage melanoma.The procedure requires close collaboration of surgeon, pathologist, and nuclear medicine physician.The strength of lymphatic mapping and sentinel node biopsy is its accuracy of detecting occult lymph node metastases. Reverse transcriptase-PCR (RT-PCR) analyses of either fresh-frozen or paraffinembedded sections of the sentinel lymph nodes have been found to be more sensitive than H&E staining or immunohistochemistry techniques, but lack of specificity and limits in the availability of tissue specimens make this technique impractical for routine use. Three randomized clinical trials are examining the therapeutic value of lymphatic mapping and sentinel node biopsy for melanoma. Preliminary results of the Multicenter LymphadenectomyTrial I show the high level of accuracy and low morbidity of lymphatic mapping and sentinel node biopsy done through an international working group.The therapeutic value of lymphatic mapping and sentinel node biopsy is still unclear. Multicenter Lymphadenectomy Trial II will test the clinical significance of lymph nodes evaluated by RT-PCR and the value of completion lymph node dissection for patients found to have tumor-positive sentinel lymph nodes by H&E, immunohistochemistry, or RT-PCR. The Sunbelt Melanoma Trial examines the therapeutic value of completion dissection and benefits of Intron A. The ability to detect occult nodal metastases and evaluate the interaction of primary tumor with the regional lymph nodes may provide for better understanding of the metastatic process in patients with melanoma and help to determine the function of the regional lymph nodes as markers of metastases or incubators of tumor cells in the metastatic cascade.

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“…Data showed a significantly (P = 0.01) higher 5-year disease-free survival (78%) for patients undergoing LM/SNB compared with those undergoing wide excision alone (73%). No difference was apparent in overall survival between the two treatment groups; yet, tumor status of the sentinel node remained the strongest predictor of outcome in these patients (9).…”

Section: Staging and Local And Regional Therapymentioning

confidence: 99%

Innovations and Challenges in Melanoma: Summary Statement from the First Cambridge Conference

Atkins

Elder

Essner

et al. 2006

Clinical Cancer Research

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Innovations and Challenges in Melanoma, chaired by Michael Atkins and cochaired by Ulrich Keilholz, John Kirkwood, and Jeffrey Sosman, was held July 15 to 16, 2005, in Cambridge, Massachusetts. The conference brought together leading experts in the fields of cancer research, medical oncology, surgical oncology, anatomic pathology, dermatology, and immunotherapy who wished to advance the field of melanoma treatment by exchanging information and perspectives regarding recent advances and recommendations for further study. The conference proceedings published in this educational supplement to Clinical Cancer Research are intended to provide timely information and recommendations on how genetics, biology, and data information can enhance our understanding of melanoma biology and help inform the use of therapies for this disease. Epidemiology, Biology, and PathologyAlthough substantial efforts have been devoted to the improvement of melanoma treatment, the mainstay of treatment remains surgical excision. This treatment may be curative for patients with early disease and for some patients with regional lymph node metastases but has a less defined role in patients with distant metastases. Other treatments, including adjuvant therapy for resected regional disease or chemotherapy or immunotherapy for metastatic disease, provide only modest improvement in outcome. Therefore, it is essential that melanoma be detected early. Early detection is the major factor responsible for progress in melanoma treatment during the past 30 years and remains the most promising avenue for short-term and medium-term progress.To improve our early detection activities, we must inspect and recognize the curable melanomas when they become visible on the skin (1). These early detection activities can be done by both clinicians and patients. Current efforts to encourage such activities include the ABCD method, the Basic Skin Cancer Triage, and the Check-It-Out Project.For the past 20 years, early detection and screening for the public have focused on ABCD: A for asymmetry, B for irregular border, C for multiple colors, and D for diameter of >6 mm (2). This tool has been useful, but ambiguity exists regarding the threshold for action (presumably, the presence of just one of these features should precipitate a visit to the physician, but some may think that a lesion does not require action until two or more of these features are present). More importantly, melanomas do not necessarily manifest any of these signs. The Basic Skin Cancer Triage (3) is an eight-step algorithm that allows the clinician to triage patients and skin lesions into one of three categories: act (requires biopsy or referral), reassure (patient can be confidently reassured), and track (requires nearterm surveillance to be sure it is stable). The Check-It-Out Project evaluated an intervention to increase thorough skin selfexamination in a randomized trial. At baseline, the main predictors of thorough skin self-examination performance were (a) having been advised to do so ...

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Interim results of the Multicenter Selective Lymphadenectomy Trial (MSLT-I) in clinical stage I melanoma

Cited by 55 publications

References 0 publications

What is the impact of sentinel node biopsy in the management of cancer?

What is the impact of sentinel node biopsy in the management of cancer?

Sentinel Lymph Node Biopsy and Melanoma Biology

Innovations and Challenges in Melanoma: Summary Statement from the First Cambridge Conference

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