Completion lymph node dissection (CLND) after positive sentinel lymph node biopsy (SLNB) for cutaneous melanoma remains controversial. The second Multicenter Selective Lymphadenectomy Trial (MSLT-II) explained no survival benefit with CLND after observing the patients with a positive SLNB. However, these findings may have limited applicability to the high-risk population, which observes rationed nodal ultrasound and nonsurgical melanoma treatment. 

A recent regional, retrospective study reviewed primary melanoma, SLNB and CLND histopathological reports in the Bay of Plenty District Health Board (BOPDHB) across 10 years. It evaluated the size of sentinel lymph node metastases and nonsentinel node (NSN) positivity on CLND for patients with a positive SLNB.

• The study identified 157 SLNB in which the mean sentinel lymph node metastatic deposit size was larger in BOPDHB compared with MSLT-II (3.53 vs. 1.07/1.11 mm).
• A greater proportion of BOPDHB patients (54.8%) showed metastatic deposits >1 mm compared with MSLT-II (33.2/34.5%).
• Also, these patients had a higher rate of NSN involvement in CLND (23.8% vs. 11.5%). 

These findings imply that the BOPDHB is a high-risk population for nodal melanoma metastases. These patients may be at risk if we ignore CLND when SLNB is positive.

Source: Williams TS, Tallon B, Adams BM. Melanoma sentinel lymph node biopsy and completion lymph node dissection: a regional hospital experience. J Plast Reconstr Aesthet Surg. 2022;75(2):730-6.