TY - JOUR
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.
N1 - Funding Information:
Supported by the American College of Surgeons Clinical Scholars in Residence program (K.Y.B.).
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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U2 - 10.1245/s10434-008-9885-2
DO - 10.1245/s10434-008-9885-2
M3 - Article
C2 - 18414952
AN - SCOPUS:43449103331
SN - 1068-9265
VL - 15
SP - 1566
EP - 1576
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 6
ER -