Complete lymph node dissection for sentinel node-positive melanoma: Assessment of practice patterns in the United States

Karl Y. Bilimoria, Charles M. Balch, David J. Bentrem, Mark S. Talamonti, Clifford Y. Ko, Julie R Lange, David P. Winchester, Jeffrey D. Wayne

Research output: Contribution to journalArticle

Abstract

Background: Currently, complete lymph node dissection (CLND) is recommended after identification of a metastatic lymph node by sentinel lymph node biopsy (SLNB). Guidelines suggest that CLND should be performed as a separate procedure, and a sufficient number of nodes should be examined. Our objective was to examine the utilization, timing, and adequacy of CLND for melanoma in the United States. Methods: From the National Cancer Data Base, patients diagnosed with stage I to III melanoma during 2004-2005 were identified. Multiple logistic regression was used to assess factors associated with CLND utilization, timing (separate operation from SLNB), and adequacy (examination of ≥10 nodes). Results: Of the 44,548 patients identified, 47.5% were pathologic stage IA, 23.8% stage IB, 14.1% stage II, and 14.6% stage III. Of the 17% (2942 of 17,524) with nodal metastases on SLNB, only 50% underwent a CLND. Patients were significantly less likely to undergo a CLND after SLNB if >75 years old or had lower extremity melanomas. Of the patients who underwent a CLND, only 42% underwent the CLND at a separate procedure after the SLNB. Of those who underwent a CLND, 69.2% had ≥10 nodes examined. Patients were significantly less likely to have ≥10 nodes examined if they were >75 years old or had lower extremity melanomas. Patients treated at NCCN/NCI-designated centers were significantly more likely to undergo nodal evaluation in concordance with established guidelines. Conclusions: Only half of patients with sentinel node-positive melanoma underwent CLND. Quality surveillance measures are needed to monitor, standardize, and improve the care of patients with malignant melanoma.

Original languageEnglish (US)
Pages (from-to)1566-1576
Number of pages11
JournalAnnals of Surgical Oncology
Volume15
Issue number6
DOIs
StatePublished - Jun 2008

Fingerprint

Lymph Node Excision
Melanoma
Sentinel Lymph Node Biopsy
Lower Extremity
cyhalothrin
Guidelines
Patient Care
Logistic Models
Lymph Nodes
Databases
Neoplasm Metastasis

Keywords

  • Completion lymph node dissection
  • Lymph node
  • Melanoma
  • Sentinel lymph node biopsy
  • Skin neoplasm
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Complete lymph node dissection for sentinel node-positive melanoma : Assessment of practice patterns in the United States. / Bilimoria, Karl Y.; Balch, Charles M.; Bentrem, David J.; Talamonti, Mark S.; Ko, Clifford Y.; Lange, Julie R; Winchester, David P.; Wayne, Jeffrey D.

In: Annals of Surgical Oncology, Vol. 15, No. 6, 06.2008, p. 1566-1576.

Research output: Contribution to journalArticle

Bilimoria, Karl Y. ; Balch, Charles M. ; Bentrem, David J. ; Talamonti, Mark S. ; Ko, Clifford Y. ; Lange, Julie R ; Winchester, David P. ; Wayne, Jeffrey D. / Complete lymph node dissection for sentinel node-positive melanoma : Assessment of practice patterns in the United States. In: Annals of Surgical Oncology. 2008 ; Vol. 15, No. 6. pp. 1566-1576.
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abstract = "Background: Currently, complete lymph node dissection (CLND) is recommended after identification of a metastatic lymph node by sentinel lymph node biopsy (SLNB). Guidelines suggest that CLND should be performed as a separate procedure, and a sufficient number of nodes should be examined. Our objective was to examine the utilization, timing, and adequacy of CLND for melanoma in the United States. Methods: From the National Cancer Data Base, patients diagnosed with stage I to III melanoma during 2004-2005 were identified. Multiple logistic regression was used to assess factors associated with CLND utilization, timing (separate operation from SLNB), and adequacy (examination of ≥10 nodes). Results: Of the 44,548 patients identified, 47.5{\%} were pathologic stage IA, 23.8{\%} stage IB, 14.1{\%} stage II, and 14.6{\%} stage III. Of the 17{\%} (2942 of 17,524) with nodal metastases on SLNB, only 50{\%} underwent a CLND. Patients were significantly less likely to undergo a CLND after SLNB if >75 years old or had lower extremity melanomas. Of the patients who underwent a CLND, only 42{\%} underwent the CLND at a separate procedure after the SLNB. Of those who underwent a CLND, 69.2{\%} had ≥10 nodes examined. Patients were significantly less likely to have ≥10 nodes examined if they were >75 years old or had lower extremity melanomas. Patients treated at NCCN/NCI-designated centers were significantly more likely to undergo nodal evaluation in concordance with established guidelines. Conclusions: Only half of patients with sentinel node-positive melanoma underwent CLND. Quality surveillance measures are needed to monitor, standardize, and improve the care of patients with malignant melanoma.",
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T1 - Complete lymph node dissection for sentinel node-positive melanoma

T2 - Assessment of practice patterns in the United States

AU - Bilimoria, Karl Y.

AU - Balch, Charles M.

AU - Bentrem, David J.

AU - Talamonti, Mark S.

AU - Ko, Clifford Y.

AU - Lange, Julie R

AU - Winchester, David P.

AU - Wayne, Jeffrey D.

PY - 2008/6

Y1 - 2008/6

N2 - Background: Currently, complete lymph node dissection (CLND) is recommended after identification of a metastatic lymph node by sentinel lymph node biopsy (SLNB). Guidelines suggest that CLND should be performed as a separate procedure, and a sufficient number of nodes should be examined. Our objective was to examine the utilization, timing, and adequacy of CLND for melanoma in the United States. Methods: From the National Cancer Data Base, patients diagnosed with stage I to III melanoma during 2004-2005 were identified. Multiple logistic regression was used to assess factors associated with CLND utilization, timing (separate operation from SLNB), and adequacy (examination of ≥10 nodes). Results: Of the 44,548 patients identified, 47.5% were pathologic stage IA, 23.8% stage IB, 14.1% stage II, and 14.6% stage III. Of the 17% (2942 of 17,524) with nodal metastases on SLNB, only 50% underwent a CLND. Patients were significantly less likely to undergo a CLND after SLNB if >75 years old or had lower extremity melanomas. Of the patients who underwent a CLND, only 42% underwent the CLND at a separate procedure after the SLNB. Of those who underwent a CLND, 69.2% had ≥10 nodes examined. Patients were significantly less likely to have ≥10 nodes examined if they were >75 years old or had lower extremity melanomas. Patients treated at NCCN/NCI-designated centers were significantly more likely to undergo nodal evaluation in concordance with established guidelines. Conclusions: Only half of patients with sentinel node-positive melanoma underwent CLND. Quality surveillance measures are needed to monitor, standardize, and improve the care of patients with malignant melanoma.

AB - Background: Currently, complete lymph node dissection (CLND) is recommended after identification of a metastatic lymph node by sentinel lymph node biopsy (SLNB). Guidelines suggest that CLND should be performed as a separate procedure, and a sufficient number of nodes should be examined. Our objective was to examine the utilization, timing, and adequacy of CLND for melanoma in the United States. Methods: From the National Cancer Data Base, patients diagnosed with stage I to III melanoma during 2004-2005 were identified. Multiple logistic regression was used to assess factors associated with CLND utilization, timing (separate operation from SLNB), and adequacy (examination of ≥10 nodes). Results: Of the 44,548 patients identified, 47.5% were pathologic stage IA, 23.8% stage IB, 14.1% stage II, and 14.6% stage III. Of the 17% (2942 of 17,524) with nodal metastases on SLNB, only 50% underwent a CLND. Patients were significantly less likely to undergo a CLND after SLNB if >75 years old or had lower extremity melanomas. Of the patients who underwent a CLND, only 42% underwent the CLND at a separate procedure after the SLNB. Of those who underwent a CLND, 69.2% had ≥10 nodes examined. Patients were significantly less likely to have ≥10 nodes examined if they were >75 years old or had lower extremity melanomas. Patients treated at NCCN/NCI-designated centers were significantly more likely to undergo nodal evaluation in concordance with established guidelines. Conclusions: Only half of patients with sentinel node-positive melanoma underwent CLND. Quality surveillance measures are needed to monitor, standardize, and improve the care of patients with malignant melanoma.

KW - Completion lymph node dissection

KW - Lymph node

KW - Melanoma

KW - Sentinel lymph node biopsy

KW - Skin neoplasm

KW - Surgery

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