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Complete Lymph Node Dissection for Sentinel Node-Positive Melanoma: Assessment of Practice Patterns in the United States

¹ Cancer Programs, American College Surgeons, Chicago, IL, USA
² Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
³ Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
⁴ Department of Surgery, Evanston Northwestern Healthcare, Evanston, IL, USA
⁵ Department of Surgery, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
⁶ VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA

Correspondence: Address correspondence and reprint requests to: Karl Y. Bilimoria, MD, MS; E-mail: k-bilimoria{at}northwestern.edu

Background: Currently, complete lymph node dissection (CLND) is recommended after identification of a metastatic lymph node by sentinel lymph node biopsy (SLNB). Guidelines suggest that CLND should be performed as a separate procedure, and a sufficient number of nodes should be examined. Our objective was to examine the utilization, timing, and adequacy of CLND for melanoma in the United States.

Methods: From the National Cancer Data Base, patients diagnosed with stage I to III melanoma during 2004–2005 were identified. Multiple logistic regression was used to assess factors associated with CLND utilization, timing (separate operation from SLNB), and adequacy (examination of 10 nodes).

Results: Of the 44,548 patients identified, 47.5% were pathologic stage IA, 23.8% stage IB, 14.1% stage II, and 14.6% stage III. Of the 17% (2942 of 17,524) with nodal metastases on SLNB, only 50% underwent a CLND. Patients were significantly less likely to undergo a CLND after SLNB if >75 years old or had lower extremity melanomas. Of the patients who underwent a CLND, only 42% underwent the CLND at a separate procedure after the SLNB. Of those who underwent a CLND, 69.2% had 10 nodes examined. Patients were significantly less likely to have 10 nodes examined if they were >75 years old or had lower extremity melanomas. Patients treated at NCCN/NCI-designated centers were significantly more likely to undergo nodal evaluation in concordance with established guidelines.

Conclusions: Only half of patients with sentinel node-positive melanoma underwent CLND. Quality surveillance measures are needed to monitor, standardize, and improve the care of patients with malignant melanoma.

Key Words: Melanoma • Skin neoplasm • Sentinel lymph node biopsy • Completion lymph node dissection • Lymph node • Surgery

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