Latest update from one of our advisors, Myles Smith.  Myles is a Consultant General Surgeon and Surgical Oncologist at the Royal Marsden.  He provides regular updates for us.

Multicenter Selective Lymphadenectomy Trial. 

A major international randomised trial, MSLT-1 (Multicenter Selective Lymphadenectomy Trial) was set up to test whether performing a sentinel node biopsy and removing all of the nodes early if a positive node was identified would improve survival, when compared to clinical examination and taking out the nodes if they became clinically apparent (usually swollen). Although people have argued that removing all nodes when the sentinel node is positive, the trial did not show improved survival in these patients.  (http://www.nejm.org/doi/full/10.1056/NEJMoa1310460).

That was a very important finding, as a lymph node dissection can have significant morbidity (surgical side-effects) – up to 15% of people may develop lymphoedema, and in the groin 30-40 of people develop wound complications such as infection, wound breakdown and seromas.
Two recent trials, the follow up MSLT trial (MSLT-2 [http://www.nejm.org/doi/full/10.1056/NEJMoa1613210]) and the German DeCOG-SLT (http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(16)00141-8/abstract) have further informed our approach to sentinel node biopsy.

Both were randomised trials that examined whether there was a difference in survival when monitoring patients with ultrasound after a positive sentinel node biopsy, in comparison with dissecting all of the lymph nodes. Both trials found that there was no difference in survival, but the majority of patients could avoid a further operation, and complications. If lymph nodes were identified during follow up, they could be safely removed. The number of patients in MSLT-2 who had a recurrence of melanoma in the lymph nodes only was 6.4% higher in the ultrasound group. Although one can consider a node dissection, in particular if there is no facility for ultrasound surveillance at your treating centre, or if it is a personal preference, in general it need not be performed, which is good news for many melanoma.

We are very grateful to Myles for his continued support.