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Surveillance of Sentinel Node-Positive Melanoma Patients Who Receive Adjuvant Therapy Without Undergoing Completion Lymph Node Dissection

  • Melanoma
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Abstract

Introduction

Adjuvant therapy trials required completion lymph node dissection (CLND) for sentinel lymph node (SLN)-positive melanoma prior to systemic treatment, but nodal surveillance without CLND is now common. For patients receiving adjuvant therapy without CLND, patterns of recurrence are unknown and the value of regional nodal ultrasound alongside cross-sectional imaging is not well-defined.

Methods

In a retrospective cohort of SLN-positive melanoma patients managed with nodal surveillance from June 2014 to June 2019, we evaluated the association between adjuvant treatment and location of first recurrence (locoregional, nodal, distant, or multisite) using Chi-square tests. We compared methods of recurrence detection and cost by surveillance intensity using Chi-square and Dunn’s tests.

Results

Among 177 nodal surveillance patients, 66 (37%) received adjuvant therapy. Median follow-up was 24 months, during which 48 patients (27%) recurred. Adjuvant treatment did not alter patterns of initial recurrence (p = 0.76). Adjuvant therapy recipients more often had both nodal ultrasound and cross-sectional imaging surveillance (p < 0.01). Among 13 isolated nodal recurrences, 85% were within the first year and 85% were detected by examination and/or ultrasound. Increasing surveillance intensity was not associated with recurrence detection rates but increased overall cost and cost per detected recurrence.

Conclusion

Regardless of adjuvant treatment, most nodal recurrences occurred in the first year and were initially detected clinically or by ultrasound. Findings support continued use of examination and nodal basin ultrasound in addition to any planned cross-sectional imaging surveillance.

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Acknowledgments

This study was supported by the Junior Scientist Research Program at H. Lee Moffitt Cancer Center (Awardees: Kristy K. Broman, Jaileene Perez-Morales, Deepti Bettampadi).

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Authors and Affiliations

  1. H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    Kristy K. Broman MD, MPH, Deepti Bettampadi MD, PhD, MPH, Jaileene Pérez-Morales PhD, James Sun MD, Michael J. Carr MD, MS, Zeynep Eroglu MD, Ahmad A. Tarhini MD, PhD, Nikhil Khushalani MD, Matthew B. Schabath PhD, Amod Sarnaik MD, Vernon K. Sondak MD & Jonathan S. Zager MD

  2. University of South Florida Morsani College of Medicine, Tampa, FL, USA

    Kristy K. Broman MD, MPH, Dennis Kirichenko MS, Zeynep Eroglu MD, Ahmad A. Tarhini MD, PhD, Nikhil Khushalani MD, Matthew B. Schabath PhD, Amod Sarnaik MD, Vernon K. Sondak MD & Jonathan S. Zager MD

  3. University of Alabama at Birmingham, Birmingham, AL, USA

    Kristy K. Broman MD, MPH

  4. University Hospital Cleveland Medical Center, Cleveland, OH, USA

    James Sun MD

Authors
  1. Kristy K. Broman MD, MPH
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  2. Deepti Bettampadi MD, PhD, MPH
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Corresponding author

Correspondence to Kristy K. Broman MD, MPH.

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Disclosure

Zeynep Eroglu served on the advisory boards of Array Biopharma, Regeneron, OncoSec, Genentech, Novartis, SunPharma, and Natera, and receives research funding from Novartis. Ahmad A. Tarhini has received fees for consulting and/or advisory board participation from Partner Therapeutics, Merck, Bristol Myers Squibb, Novartis, Genentech-Roche, Array Biopharma, Sanofi-Genzyme/Regeneron, Pfizer, EMD Serono, NewLink Genetics, BioNTech, Immunocore, and Eisai; has participated in a Data Safety Monitoring Board for Incyte; and has been involved in institution contracted research with Merck, OncoSec, Genentech-Roche, Bristol Myers Squibb, and Clinigen within the last 3 years. Nikhil Khushalani has received personal fees from Regeneron, Inc./Sanofi, Array BioPharma, AstraZeneca, EMD Serono, Genentech, Immunocore, Incyte, Jounce Therapeutics Merck, and Sanofi. He has received research grants and personal fees from Amgen, Gelgene, GlaxoSmithKline, Novartis, and Regeneron, and has received stock or other ownership interest from Amarin Corporation, Bellicum Pharmaceuticals, Mazor Robotics, and TransEnterix. Amod Sarnaik is a consultant to Iovance Biotherapeutics, Guidepoint, Defined Health, and Gerson Lehman group. His institution has received research funding from Iovance Biotherapeutics and Provectus Inc., and he has received speaker fees from Physicians’ Education Resource and Medscape. Vernon K. Sondak is a paid consultant to Merck, Bristol Myers Squibb, Novartis, Regeneron, Array, Replimune, Pfizer, Genentech/Roche, Eisai, Aduro, Amgen, TRM Oncology, and Polynoma. Jonathan S. Zager has received research funding from Novartis, Philogen, Delcath Systems, Amgen, Provectus, Novartis and Castle Biosciences. He has served on advisory boards for Merck, Novartis and Pfizer, and on the speakers bureau for Pfizer, Sun Pharma, and Castle Biosciences. He also provides expert testimony to McGowan Hood and Bubalo Law. Kristy K. Broman, Deepti Bettampadi, Jaileene Pérez-Morales, James Sun, Dennis Kirichenko, Michael J. Carr, and Matthew B. Schabath reported no disclosures.

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Broman, K.K., Bettampadi, D., Pérez-Morales, J. et al. Surveillance of Sentinel Node-Positive Melanoma Patients Who Receive Adjuvant Therapy Without Undergoing Completion Lymph Node Dissection. Ann Surg Oncol 28, 6978–6985 (2021). https://doi.org/10.1245/s10434-021-10570-5

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