# MSLT-II: completion lymph node dissection or observation for sentinel-node metastasis in melanoma

Source: https://onco.cc/key-papers/paper-mslt-ii-faries-nejm-2017/  
OnCo record `paper-mslt-ii-faries-nejm-2017` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Removing all the remaining lymph nodes after a positive sentinel node did not improve melanoma survival compared with ultrasound surveillance and caused far more lymphoedema, ending routine completion dissection.

## Summary

Phase 3 trial of 1,939 patients with sentinel node-positive melanoma randomised to immediate completion lymph node dissection or nodal observation with ultrasound.

Three-year melanoma-specific survival was 86 percent in both groups; dissection improved regional disease control and gave prognostic information but caused lymphoedema in 24 versus 6 percent.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: New England Journal of Medicine
- Year: 2017
- DOI: 10.1056/NEJMoa1613210
- Authors: Faries MB, Thompson JF, Cochran AJ, et al.
- Findings: Three-year melanoma-specific survival 86 percent in both groups.; Lymphoedema 24.1 percent vs 6.3 percent.
- What it means: Patients with a positive sentinel node are now managed with surveillance and adjuvant systemic therapy rather than completion dissection.
- Caveats: Most patients had low-volume sentinel node disease; the trial was not powered for those with high nodal burden.

## Sources

- N Engl J Med 2017: https://doi.org/10.1056/NEJMoa1613210
- PubMed: https://pubmed.ncbi.nlm.nih.gov/28591523/

## Connected records

- cancers: [Stage III melanoma (after surgery)](https://onco.cc/cancers/stage-iii-melanoma/)
- trials: [MSLT-II](https://onco.cc/trials/mslt-ii/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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