High-risk melanoma: Use of targeted therapies up, sentinel lymph node dissection down


Nodular melanoma. Photo by DermNetNZ via Wikimedia Commons

Data collected from 21 melanoma referral centres in the U.S., Europe, and Australia reveals that, over the last five years, the use of targeted and immune therapies such as pembrolizumab and ipilimumab for the treatment of sentinel lymph node (SLN)-positive melanoma has risen rapidly, while lymph node removal surgery has become less common.


In the study from the International High-Risk Melanoma Consortium, published in Annals of Surgery, the researchers evaluated overall trends and variations in care regarding the utilization of completion lymph node dissection (CLND) and adjuvant systemic therapy for SLN-positive melanoma.


According to the researchers, in 1,109 patients evaluated, adjuvant systemic therapy use increased to 60% from 29% while CLND decreased to 8% from 28%. The most important factors determining the treatment approach included nodal tumour size, stage, and the location of the treatment centre. However, the authors identified notable variations among the 21 centres. In a press release, the authors attributed these differences to regulations and health insurance systems in the U.S. compared to Europe and Australia. Individual preferences of physicians also are likely factors, they said.


Although it can often take a significant length of time for providers to shift their practices in response to research developments, the consortium saw signs these providers not only knew about the latest melanoma research but were also applying it in their practices.


“What this study shows is that, unlike the pace of adoption that we see for many scientific innovations, these research findings were adopted very quickly and quite broadly at major melanoma referral centres across the world,” said first author Dr. Kristy K. Broman, an assistant professor of surgery at the University of Alabama at Birmingham in the press release.


“We think this may be related to the potential lifelong complications of lymph node removal surgery, which surgeons and patients alike would readily choose to avoid when the surgery is unnecessary, as well as how effective the new systemic treatments are in a landscape where, only 10 years ago, we had no effective systemic therapies.”

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