![]() ![]() Participants in MSLT-II were 18–75 years old and had a skin melanoma of intermediate thickness (1.2 to 3.5 millimeters) that had spread to the sentinel lymph nodes but not to other parts of the body. “It seems logical to take those nodes out, even if we can’t detect melanoma there yet,” to keep the cancer from spreading, explained MSLT-II lead investigator Mark Faries, M.D., a surgical oncologist at the Angeles Clinic and Research Institute, an affiliate of Cedars-Sinai Medical Center, in Los Angeles.īut, until now, the survival benefit of this “completion” lymph node surgery had been unclear. If the biopsy reveals melanoma cells in the sentinel nodes, doctors usually recommend immediate removal of the remaining regional lymph nodes. Most patients with newly diagnosed melanoma undergo a sentinel lymph node biopsy, in which the sentinel lymph nodes are removed and examined to find out if the cancer has spread from the skin. “This is a very clear-cut, definitive result…that signals a turn in direction” for the care of people with melanoma, agreed Howard Streicher, M.D., of NCI’s Cancer Therapy Evaluation Program, who was not involved in the trial. “These results should be construed as practice changing,” Daniel Coit, M.D., of Memorial Sloan Kettering Cancer Center, wrote in an accompanying editorial. The results of the second Multicenter Selective Lymphadenectomy Trial (MSLT-II), which was funded in part by NCI, were published June 8 in the New England Journal of Medicine. Patients who underwent the more aggressive surgery, the trial showed, also had far more post-surgical complications. In the trial, there was no difference in melanoma-specific survival between patients who had only the lymph nodes to which the cancer was most likely to spread, known as sentinel lymph nodes, removed and patients who had more extensive surgery to remove additional nearby lymph nodes. A conservative approach to lymph node removal surgery may be best for people with melanoma that has spread from the skin to one or a small number of nearby lymph nodes, new results from a large international clinical trial suggest. ![]()
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