Effectiveness of Sentinel Lymph Node Biopsy in Patients With Newly Diagnosed Melanoma

Key Points

  • The recently published Australian Clinical Practice Guidelines for the Diagnosis and Management of Melanoma recommends that “sentinel lymph node biopsy should be considered for all patients with melanoma greater than 1 mm in thickness and for patients with melanoma greater than 0.8 mm with other high-risk pathological features to provide optimal staging and prognostic information and to maximize management options for patients who are node-positive.”
  • This biopsy can identify patients whose melanoma has metastasized beyond the site on the skin and who may be suitable to receive the new generation of antimelanoma drugs.

     

Research presented at the 9th World Congress of Melanoma supports the updated guideline recommendation that sentinel lymph node biopsy be performed in more patients newly diagnosed with melanoma, as it has the potential to save lives due to the information the procedure provides.

This biopsy can identify patients whose melanoma has metastasized beyond the site on the skin (stage III melanoma) and who may be suitable to receive the new generation of antimelanoma drugs.

The recently published Australian Clinical Practice Guidelines for the Diagnosis and Management of Melanoma recommends that “sentinel lymph node biopsy should be considered for all patients with melanoma greater than 1 mm in thickness and for patients with melanoma greater than 0.8 mm with other high-risk pathological features to provide optimal staging and prognostic information and to maximize management options for patients who are node-positive.”

David Gyorki, MBBS, MD, FRACS, a consultant surgeon and melanoma specialist at the Peter MacCallum Cancer Centre, commented: “We know patients who have melanoma cells present in their draining lymph nodes (stage III) are up to three times more likely to die from their melanoma than patients where the lymph nodes are clear. For some time, we’ve known that sentinel lymph node biopsy is an excellent way to identify those patients who have a higher risk of having their disease progress, and with the new drugs we have gained the tools to respond and to reduce this risk.”

He concluded, “On the horizon, we will have access to effective, well tolerated drug therapies that can reduce the risk of relapse and, using sentinel lymph node biopsy to identify appropriate patients, the data indicate that this strategy is saving lives.”

Findings from recent clinical trials have demonstrated a major improvement in survival for patients with stage III melanoma using drug therapy after surgery with the aim of preventing the melanoma from metastasizing to distant organs (stage IV disease).

In one such clinical trial—COMBI-AD—patients who received a combination of targeted therapies (dabrafenib and trametinib) decreased the chance of their melanoma progressing by 53% compared to the current standard therapy of “watch and wait.”

“We encourage clinicians to inform their patients about sentinel lymph node biopsy so that patients can properly understand their risk of recurrence and death from melanoma and discuss the option of further drug therapy,” said Professor Georgina Long, BSc, PhD, MBBS, FRACP, Medical Oncologist and Co-Medical Director of Melanoma Institute Australia.

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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