No survival benefit to removing all lymph nodes in melanoma, new trial finds

Removing further lymph nodes after a positive sentinel node for patients with melanoma does not improve survival, a new study published today in the New England Journal of Medicine has found.

The multi-centre, international trial that included Sunnybrook followed patients with melanoma over 10 years after randomizing them to complete lymph node removal or node observation after a positive sentinel node biopsy.

Sentinel lymph node biopsy is a standard of practice for select patients with melanoma that are greater than 1mm in depth. A positive sentinel lymph node biopsy means the melanoma has spread to the lymph nodes that are nearest to the skin cancer lesion. A 10-year study completed in 2014 found that early removal of the positive sentinel node improved survival of melanoma patients.

This new phase of the study looked at removing the rest of the remaining lymph nodes after positive sentinel node biopsy versus regular testing of the remaining nodes using ultrasound. The study, which followed 1,930 patients for 10 years, found that removing all the lymph nodes after sentinel node biopsy does not increase chance of survival.

“The main beneficiaries here are the patients,” said Dr. Frances Wright, surgical oncologist at Sunnybrook and site lead on the study. “It will improve their quality of life.”

There are side effects to having the lymph nodes removed, include life-long lymphedema, swelling of the arms or legs that require a compression stocking or other treatment like lymphatic massage.

“So here are patients who have survived the cancer but have other life-long consequences that diminish their quality of life,” Dr. Wright said. “This is a key surgical trial in melanoma. This will change practice here at Sunnybrook, in Canada and around the world.”