In the setting of a positive sentinel lymph node biopsy among patients with melanoma, it is “reasonable to consider the pros and the cons” of a complete lymph node dissection, according to Michael Sabel, MD, associate professor of surgery and chief of surgical oncology at University of Michigan Comprehensive Cancer Center.
Sabel reviews the controversy surrounding the complete lymph node dissection, including the benefits and drawbacks of dissection vs. observation. Risks associated with the complete lymph node dissection include lymphedema and wound complications, while observation can increase the risk for these surgical complications later, particularly in older patients, he notes. Data from the MSLT-II trial and other investigations on the complete lymph node dissection is forthcoming, according to Sabel, and will help clarify the benefits of this approach.
“There is data to suggest that only a minority of patients will have additional disease discovered in the non-sentinel nodes and … enough data at least suggesting there is a question of benefit in this situation,” he said. “… It is important that we discuss and approach each situation in a balanced manner with our patients and let them be an active participant in this decision.”