Completion dissection or observation for sentinel-node metastasis in melanoma

Research output: Contribution to journalArticle


BACKGROUND Sentinel-lymph-node biopsy is associated with increased melanoma-specific survival (i.e., survival until death from melanoma) among patients with node-positive intermediatethickness melanomas (1.2 to 3.5 mm). The value of completion lymph-node dissection for patients with sentinel-node metastases is not clear. METHODS In an international trial, we randomly assigned patients with sentinel-node metastases detected by means of standard pathological assessment or a multimarker molecular assay to immediate completion lymph-node dissection (dissection group) or nodal observation with ultrasonography (observation group). The primary end point was melanoma-specific survival. Secondary end points included disease-free survival and the cumulative rate of nonsentinel-node metastasis. RESULTS Immediate completion lymph-node dissection was not associated with increased melanomaspecific survival among 1934 patients with data that could be evaluated in an intention-Totreat analysis or among 1755 patients in the per-protocol analysis. In the per-protocol analysis, the mean (-SE) 3-year rate of melanoma-specific survival was similar in the dissection group and the observation group (86-1.3% and 86-1.2%, respectively; P = 0.42 by the logrank test) at a median follow-up of 43 months. The rate of disease-free survival was slightly higher in the dissection group than in the observation group (68-1.7% and 63-1.7%, respectively; P = 0.05 by the log-rank test) at 3 years, based on an increased rate of disease control in the regional nodes at 3 years (92-1.0% vs. 77-1.5%; P<0.001 by the log-rank test); these results must be interpreted with caution. Nonsentinel-node metastases, identified in 11.5% of the patients in the dissection group, were a strong, independent prognostic factor for recurrence (hazard ratio, 1.78; P = 0.005). Lymphedema was observed in 24.1% of the patients in the dissection group and in 6.3% of those in the observation group. CONCLUSIONS Immediate completion lymph-node dissection increased the rate of regional disease control and provided prognostic information but did not increase melanoma-specific survival among patients with melanoma and sentinel-node metastases.


  • B. Faries
  • J. F. Thompson
  • Alistair J. Cochran
  • R. H. Andtbacka
  • Nicola Mozzillo
  • J. S. Zager
  • Tiina Jahkola
  • T. L. Bowles
  • A Testori
  • P. D. Beitsch
  • H J Hoekstra
  • M. Moncrieff
  • M. W. J. M. Wouters
  • M. S. Sabel
  • E. A. Levine
  • D. Agnese
  • M Henderson
  • R. Dummer
  • C Rossi-Alvarez
  • R. I. Neves
  • S. D. Trocha
  • Alan F Wright
  • D. R. Byrd
  • M. Matter
  • E. Hsueh
  • A. MacKenzie-Ross
  • D. B. Johnson
  • P. Terheyden
  • A. C. Berger
  • T. L. Huston
  • J. D. Wayne
  • B. M. Smithers
  • H. B. Neuman
  • S. Schneebaum
  • Jeffrey E Gershenwald
  • C. E. Ariyan
  • D. C. Desai
  • L. L. Jacobs
  • K. M. McMasters
  • A. Gesierich
  • P Hersey
  • S. D. Bines
  • J. M. Kane
  • R. J. Barth
  • G. McKinnon
  • J. M. Farma
  • E. Schultz
  • Sergi Vidal-Sicart
  • R. A. Hoefer
  • Melanie J. Lewis
  • R. Scheri
  • M. C. Kelley
  • Omgo E. Nieweg
  • R. D. Noyes
  • Dave S. B. Hoon
  • H. J. Wang
  • D. A. Elashoff
  • R. M. Elashoff
External organisations
  • Saint John's Health Center
  • University of California, Los Angeles
  • Jonsson Comprehensive Cancer Center
  • Huntsman Cancer Institute
  • H. Lee Moffitt Cancer Center & Research Institute
  • Helsinki University Central Hospital
  • Intermountain Medical Center
  • European Institute of Oncology
  • Dallas Surgical Group
  • University Medical Center Groningen
  • Norfolk and Norwich University Hospital NHS Trust
  • Skåne University Hospital
  • Netherlands Cancer Institute
  • University of Michigan
  • Wake Forest University
  • Ohio State University
  • Peter MacCallum Cancer Centre
  • University of Zurich
  • University of Padova
  • Penn State Hershey Cancer Institute
  • Saint Louis University School of Medicine
  • Tom Baker Cancer Centre
  • University of Washington
  • Lausanne University Hospital
  • Guy's and St Thomas' NHS Foundation Trust
  • University Medical Center Schleswig-Holstein Campus Lubeck
  • Thomas Jefferson University
  • Sunnybrook Health Sciences Centre
  • Vanderbilt University
  • Princess Alexandra Hospital
  • Fox Chase Cancer Center
  • Greenville Health System Cancer Center (GHS)
  • Klinikum Nürnberg
  • Stony Brook University
  • St. Luke's University Health Network
  • Memorial Sloan-Kettering Cancer Center
  • Roswell Park Cancer Institute
  • Northwestern University
  • University of Wisconsin-Madison
  • Rush Presbyterian St. Luke's Medical Center
  • Tel Aviv Sourasky Medical Center – Ichilov Hospital
  • Dartmouth-Hitchcock Medical Center
  • Johns Hopkins University School of Medicine
  • University of Louisville
  • Hospital Clínic of Barcelona
  • Anderson Medical Center
  • Sentara CarePlex Hospital
  • Newcastle Melanoma Unit
  • Istituto Nazionale Tumori IRCCS - Fondazione G Pascale, Napoli
  • University of Sydney
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cancer and Oncology
Original languageEnglish
Pages (from-to)2211-2222
Number of pages12
JournalNew England Journal of Medicine
Issue number23
Publication statusPublished - 2017 Jun 8
Publication categoryResearch