MSLT-II: completion lymph node dissection or observation for sentinel-node metastasis in melanoma
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.
Overview
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.
- Three-year melanoma-specific survival 86 percent in both groups.
- Lymphoedema 24.1 percent vs 6.3 percent.
Patients with a positive sentinel node are now managed with surveillance and adjuvant systemic therapy rather than completion dissection.
- Most patients had low-volume sentinel node disease; the trial was not powered for those with high nodal burden.
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