Background
Cutaneous malignant melanoma is a skin malignancy with significant morbidity and mortality. Patients with melanoma lesions with a Breslow thickness of greater than 0.8mm may be offered a sentinel node biopsy (SNB), according to the latest guideline recommendations. Patients with positive sentinel nodes on SNB may be offered regional lymph node dissection (RLND). In 2017, a randomized controlled trial (Multicenter Selective Lymphadenectomy Trial MSLT-II) demonstrated no additional benefit of regional lymph node dissection on melanoma-specific survival compared with patients who had undergone surveillance with ultrasound guided imaging.
The aim of our audit was to assess the percentage of malignant melanoma patients with a positive sentinel node biopsy undergoing RLND and whether this had reduced following the publication of the MSLT-II study in Counties District Health Board. Our secondary outcomes included, morbidity and mortality and number of images and interventions per patient.
Methods
We identified patients with malignant melanoma who underwent a sentinel node biopsy from 2015-2020. Patients who underwent a head or neck biopsy or with distant metastases were excluded.
The total recorded eligible patients with positive SNB in the Counties Manukau was 25 (16 before-publication patients, 9 after-publication patients). 12 before-publication patients and 5 after-publication patients had been offered with RLND.
Results
There was no significant difference regarding the RLND offer comparing patients before and after the publication (p-value = 0.3942). The detected risk difference is about -19%, with a bootstrapped 95% confidence interval of (-56% – 4%).Though there was a noted reduction in the number of images and complications per patient post MSLT-II, these results were not stastically significant.