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Surgeons’ Opinions on Lymphadenectomy in Melanoma Patients with Positive Sentinel Nodes: A Worldwide Web-Based Survey

Sandro Pasquali MD, Andrew J. Spillane MD, FRACS, Johannes H. W. de Wilt MD, PhD, Kirsten McCaffery MD, PhD, Carlo R. Rossi MD, Michael J. Quinn MD, FRACS, Robyn P. Saw MS, FRACS, Kerwin F. Shannon MD, FRACS, Jonathan R. Stretch D Phil (Oxon), FRACS, John F. Thompson MD, FRACS
Melanomas
Volume 19, Issue 13 / December , 2012

Abstract

Purpose

A worldwide web-based survey was conducted among melanoma surgeons to investigate opinions about completion lymph node dissection (CLND) in patients with positive sentinel nodes (SN).

Methods

A questionnaire was designed following input from a group of melanoma surgeons. Cognitive interviews and pilot testing were performed. Surgeons identified through a systematic-review of the SN and CLND literature were invited by email.

Results

Of 337 surgeons, 193 (57.2 %) from 25 countries responded (January–July 2011). Most respondents work in melanoma (30.1 %) and surgical oncology (44.6 %) units. In patients with a positive SN, 169 (91.8 %) recommend CLND; the strength of the recommendation is mostly influenced by patient comorbidities (64.7 %) and SN tumor burden (59.2 %). Seventy-one responders enroll patients in the second Multicenter Selective-Lymphadenectomy Trial (MSLT-2), and 64 of them (76 %) suggest entering the trial to majority of patients. In cases requiring neck CLND, level 1–5 dissection is recommended by 35 % of responders, whereas 62 % base the extent of dissection on primary site and lymphatic mapping patterns. Only inguinal dissection or ilioinguinal dissection is performed by 36 and 30 % of surgeons, respectively. The remaining 34 % select either procedure according to number of positive SNs, node of Cloquet status, and lymphatic drainage patterns. Most surgeons (81 %) perform full axillary dissections in positive SN cases.

Conclusions

The majority of melanoma surgeons recommend CLND in SN-positive patients. Surgeons participating in the MSLT-2 suggest entering the trial to the majority of patients. More evidence is needed to standardize the extent of neck and groin CLND surgeries.

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