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Adjuvant Therapy for Stage III Melanoma Without Immediate Completion Lymph Node Dissection

  • Melanoma
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

For patients with stage III melanoma with occult lymph node metastasis, the use of adjuvant therapy is increasing, and completion lymph node dissection (CLND) is decreasing. We sought to evaluate the use of modern adjuvant therapy and outcomes for patients with stage III melanoma who did not undergo CLND.

Methods

Patients with a positive SLNB from 2015 to 2020 who did not undergo CLND were evaluated retrospectively. Nodal recurrence, recurrence-free survival (RFS), distant metastasis-free survival (DMFS), and melanoma-specific survival were evaluated.

Results

Among 90 patients, 56 (62%) received adjuvant therapy and 34 (38%) underwent observation alone. Patients who received adjuvant therapy were younger (mean age: 53 vs. 65, p < 0.001) and had higher overall stage (Stage IIIb/c 75% vs. 54%, p = 0.041). Disease recurred in 12 of 34 patients (35%) in the observation group and 11 of 56 patients (20%) in the adjuvant therapy group. The most common first site of recurrence was distant recurrence alone (5/34 patients) in the observation group and nodal recurrence alone (8/90 patients) in the adjuvant therapy group. Despite more adverse nodal features in the adjuvant therapy group, 24-month nodal recurrence rate and RFS were not significantly different between the adjuvant and observation cohorts (nodal recurrence rate: 26% vs. 20%, p = 0.68; RFS: 75% vs. 61%, p = 0.39). Among patients with stage IIIb/c disease, adjuvant therapy was associated with a significantly improved 24-month DMFS (86% vs. 59%, p = 0.04).

Conclusions

In this early report, modern adjuvant therapy in patients who forego CLND is associated with longer DMFS among patients with stage IIIb/c disease.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Robert J. Torphy MD, PhD, Chloe Friedman MS, Felix Ho MD, Laura D. Leonard MD, Daniel Thieu BS, Camille L. Stewart MD, Martin D. McCarter MD & Ana Gleisner MD, PhD

  2. Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Karl D. Lewis MD, Theresa M. Medina MD, William A. Robinson MD, PhD & Rene C. Gonzalez MD

  3. Melanoma Sarcoma Specialists of Georgia, Northside Cancer Institute, Atlanta, GA, USA

    Nicole Kounalakis MD

Authors
  1. Robert J. Torphy MD, PhD
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  2. Chloe Friedman MS
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  3. Felix Ho MD
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  4. Laura D. Leonard MD
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  5. Daniel Thieu BS
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  6. Karl D. Lewis MD
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  7. Theresa M. Medina MD
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  8. William A. Robinson MD, PhD
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  9. Rene C. Gonzalez MD
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  10. Camille L. Stewart MD
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  11. Nicole Kounalakis MD
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  12. Martin D. McCarter MD
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  13. Ana Gleisner MD, PhD
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Correspondence to Ana Gleisner MD, PhD.

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Torphy, R.J., Friedman, C., Ho, F. et al. Adjuvant Therapy for Stage III Melanoma Without Immediate Completion Lymph Node Dissection. Ann Surg Oncol 29, 806–815 (2022). https://doi.org/10.1245/s10434-021-10775-8

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  • DOI: https://doi.org/10.1245/s10434-021-10775-8

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