In melanoma, the lymph nodes are the most common site of metastasis. According to results of the Multicenter Lymphadenectomy Trial I (MSLT-1) published in February 2014, the status of the sentinel nodes as determined through biopsy is the most important factor in shaping a patient’s prognosis.
Still unclear, however, is whether a patient who has had a positive sentinel lymph node biopsy should have more than just the primary node (or nodes) draining the melanoma removed. Traditionally, the decision to remove all the lymph nodes in a nodal basin has been determined by the presence of a positive sentinel lymph node biopsy or the presence of disease detected on physical exam.
At Memorial Sloan Kettering, we’re taking steps to clarify this question with a recently completed accrual for a follow-up trial to MSLT-1 — the Multicenter Lymphadenectomy Trial II (MSLT-II).
In the trial, patients with a positive sentinel lymph node biopsy were randomized to a complete lymph node dissection or ultrasound surveillance of the lymph node basin. (While trial results are pending, we are offering our patients standard lymph node dissection.)
Complications of lymph node removal include lymphedema and wound problems. A particular concern to patients undergoing removal of lymph nodes from the groin is infection or separation of the groin incision, which can prolong recovery from surgery.
At MSK, we carry out lymph node dissections in selected patients through a minimally invasive approach involving small incisions in the leg. While the rate of lymphedema is not altered, the incidence of wound problems is decreased.