Home Forums Melanoma: Stage III Great discussion on SLNB and prognosis

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    Catherine Poole


    It is a discussion showing improved survival for SLNB but it is a staging tool for folks with intermediate thickness melanomas, not a treatment, but the follow up work on whether a full node dissection is necessary when mets are found is still not in. I would trust the viewpoint of Dan Coit:

    Daniel G. Coit, MD: ” MSLT-1 is probably the highest-quality data defining the role of SLNB in melanoma. I don’t care how the investigators analyzed the results, I care that the trial has provided top-quality data: The interpretation is up to the readers, clinicians and patients.

    And it very clearly confirmed that sentinel node status is the most important prognostic factor in intermediate-thickness melanoma. This is what has kept SLNB in the forefront of management of patients with intermediate-thickness melanoma.

    The other thing it showed us is that it is probable that positive sentinel nodes will evolve into clinical disease. Additionally, it said that SLNB detects about 25% of the nodes that will develop into regional disease—that is, the false-negative rate is about 25%. And also, if you take all comers, SLNB is a staging procedure and not clearly a treatment, because the study could not demonstrate an improvement in melanoma-specific survival. The distant DFS curve is an extremely important curve that has never been shown.

    The point that people really struggle with is that the study didn’t show an improvement in melanoma-specific survival even though DFS and nodal recurrence did improve. I believe it’s because the study was under-powered to show a statistically significant difference in melanoma-specific survival.

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