Delaying Lymph Node Biopsy After Melanoma Diagnosis May Not Adversely Affect Survival Rates

Key Points

  • Of 2,483 patients, positive sentinel lymph nodes were identified in 432 patients (17%). A majority of patients (58%) underwent early sentinel lymph node biopsy.
  • The study found no difference in melanoma-specific survival or disease-free survival in patients who underwent early or delayed sentinel lymph node biopsy.
  • An independent dataset from the first Multicenter Selective Lymphadenectomy Trial, a multicenter prospective randomized trial, was used to validate these findings. The exact same analysis showed similar results in survival outcomes.

Postponing lymph node biopsy more than 30 days after melanoma diagnosis does not adversely impact long-term clinical outcomes, according to findings published by Nelson et al in the Journal of the American College of Surgeons.

Today, management of high-risk melanomas starts with surgical removal of the layers of skin cancer and a lymph node biopsy. Patients with a positive sentinel node biopsy may undergo complete lymph node dissection to lower the risk of recurrence.

In theory, postponing biopsy after a melanoma diagnosis could affect outcomes, either in a negative way (ie, allowing the growth and spread of cancerous cells to lymph nodes) or in a positive way (ie, allowing development of an antimelanoma immune response).

There have been small studies showing each of those scenarios, said study coauthor Mark Faries, MD, FACS, Codirector of the Melanoma Program at The Angeles Clinic and Research Institute. “We often get questions from patients as to whether or not they need to rush to have their operation performed when they are diagnosed with melanoma. So the question of whether waiting hurts or helps has never been clearly answered,” Dr. Faries said. “We wanted to settle that controversy by looking at two very large data sets to see if there was an actual difference.”

Study Details

In this study, the largest one to date, researchers analyzed the effect of delayed sentinel lymph node biopsy on survival of patients with melanoma.

Dr. Faries and colleagues from the John Wayne Cancer Institute and elsewhere examined the medical records of 2,483 patients who underwent wide local excision and sentinel lymph node biopsy for melanoma skin cancer between 1999 and 2015. They analyzed whether lymph nodes biopsied later were associated with different outcomes, either positive or negative, compared to lymph nodes biopsied earlier. The average follow-up time was 8 years.

Early and delayed sentinel lymph node biopsy were defined as less than 30 days and more than 30 days from diagnosis, respectively. Primary outcomes included disease-free survival and melanoma-specific survival.

Findings

Of those 2,483 patients, positive sentinel lymph nodes were identified in 432 patients (17%). A majority of patients (58%) underwent early sentinel lymph node biopsy. The study found no difference in melanoma-specific survival or disease-free survival in patients who underwent early or delayed sentinel lymph node biopsy.

An independent dataset from the first Multicenter Selective Lymphadenectomy Trial, a multicenter prospective randomized trial, was used to validate these findings. The exact same analysis showed similar results in survival outcomes.

A cancer diagnosis impacts not only the body, but also the mind and emotions. Approximately one-third of patients diagnosed with melanoma report emotional challenges such as fear of death, anxiety, and uncertainty. However, it is important for people to understand that if their biopsy needs to be postponed by several weeks, they are still safe.

“When we talk to patients diagnosed with melanoma, the main rationale is to get the surgical procedure over and done with and get the information and resources they need so that they can move on,” Dr. Faries said. “But people can be reassured that if they are in a situation where, for one reason or another, they need to wait to have an operation—that's okay too.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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