Study: Common surgical treatment for melanoma does not improve patients' overall survival

June 7, 2017, Cedars-Sinai Medical Center
Melanoma in skin biopsy with H&E stain — this case may represent superficial spreading melanoma. Credit: Wikipedia/CC BY-SA 3.0

Patients who receive the standard surgical treatment for melanoma that has spread to one or more key lymph nodes do not live longer, a major new study shows.

The study, published today in The New England Journal of Medicine, found that immediately removing and performing biopsies on all lymph nodes located near the original tumor, a procedure called completion lymph node dissection, did not result in increased overall survival rates.

"The new findings likely will result in many fewer of these procedures being performed around the world," said the study's lead author, Mark B. Faries, MD, co-director of the Melanoma Program and head of Surgical Oncology at The Angeles Clinic and Research Institute, an affiliate of Cedars-Sinai. "The results also will likely affect the design of many current and future clinical trials of medical therapies in melanoma."

More than 1,900 patients with melanoma, the deadliest kind of skin cancer, participated in the study conducted at more than 60 medical institutions nationally and internationally. Faries led the research at the John Wayne Cancer Institute in Santa Monica, before joining The Angeles Clinic and Research Institute in April.

The study, among the largest ever conducted on melanoma, examines what Faries describes as the most important question facing physicians and those newly diagnosed with the disease: whether patients who have melanoma cells in a limited number of lymph nodes should undergo extensive surgery to remove all the remaining nodes in that area of the body. The results of the new research suggest they do not.

"This new approach spares patients significant negative side effects and clarifies the road forward in development of additional therapies," said Omid Hamid, MD, chief of Research/Immuno-Oncology, The Angeles Clinic and Research Institute, and co-director, Cutaneous Malignancy Program, Cedars Sinai. "Dr. Faries and colleagues' contribution to the field of surgical oncology cannot be overstated."

Although the completion dissections did not help overall survival, they did have some value, Faries said. By examining the dissected lymph nodes, physicians were able to better gauge how extensively the cancer had spread and to lengthen the time that their patients were disease-free. But those advantages did not translate into longer lives, he explained.

Additionally, nearly 25 percent of the patients who underwent the completion dissections suffered from lymphedema, compared with about 6 percent of the control group, the study found. Lymphedema is swelling that may result when lymph nodes are damaged or removed. Symptoms include hardening of the skin, infections and restricted range of motion.

"This is a larger operation that has a higher risk of complications," Faries said, "including wound infection and nerve damage."

Prior to the now-common sentinel node biopsy procedure, dissection of all regional at the early diagnosis of was the standard of care. Today, lymphatic mapping techniques are applied worldwide, and the removal of all regional nodes is undertaken only if the sentinel nodes are positive for cancer.

"The larger procedure will remain an option for some , but it will no longer be the only 'standard' option," Faries said.

Explore further: Study finds no need for lymph node surgery in some melanomas

More information: New England Journal of Medicine (2017). www.nejm.org/doi/full/10.1056/NEJMoa1613210

Related Stories

Study finds no need for lymph node surgery in some melanomas

May 30, 2015
Worldwide, people who are diagnosed with melanoma are urged to have any lymph nodes that test positive for cancer removed, but researchers said Saturday the operation doesn't necessarily help patients live longer.

Pregnancy does not increase expectant mothers' melanoma risk

April 27, 2017
Expectant mothers need not be concerned that they are more prone to develop melanoma, or will have a worse prognosis if they do get this serious skin cancer, than women who are not pregnant, according to study results published ...

Breast cancer update: Sentinel node biopsy guidelines encourage 'less is more' approach

December 12, 2016
New recommendations from breast cancer experts on sentinel lymph node biopsy reinforce the most recent "less-is-more" guidelines for early-stage disease. But a Fred Hutch researcher who helped create the guidelines said many ...

Less invasive surgery detects residual breast cancer in lymph nodes after chemotherapy

December 5, 2012
Most patients whose breast cancer has spread to their lymph nodes have most of the lymph nodes in their armpit area removed after chemotherapy to see if any cancer remains. A study conducted through the American College of ...

Some breast cancer patients on neoadjuvant chemo may avoid axillary lymph node dissection

December 7, 2016
A sentinel lymph node biopsy (SLNB) during surgery that showed no signs of cancer was associated with a low risk for breast cancer recurrence in the axillary (armpit) lymph nodes for patients with large, operable breast tumors ...

Which breast cancer patients need lymph nodes removed? Ultrasound narrows it down

February 2, 2015
Which breast cancer patients need to have underarm lymph nodes removed? Mayo Clinic-led research is narrowing it down. A new study finds that not all women with lymph node-positive breast cancer treated with chemotherapy ...

Recommended for you

Mutant cells colonize our tissues over our lifetime

October 18, 2018
By the time we reach middle age, more than half of the oesophagus in healthy people has been taken over by cells carrying mutations in cancer genes, scientists have uncovered. By studying normal oesophagus tissue, scientists ...

Study involving hundreds of patient samples may reveal new treatment options of leukemia

October 17, 2018
After more than five years and 672 patient samples, an OHSU research team has published the largest cancer dataset of its kind for a form of leukemia. The study, "Functional Genomic Landscape of Acute Myeloid Leukemia", published ...

A 150-year-old drug might improve radiation therapy for cancer

October 17, 2018
A drug first identified 150 years ago and used as a smooth-muscle relaxant might make tumors more sensitive to radiation therapy, according to a recent study led by researchers at The Ohio State University Comprehensive Cancer ...

Loss of protein p53 helps cancer cells multiply in 'unfavourable' conditions

October 17, 2018
Researchers have discovered a novel consequence of loss of the tumour protein p53 that promotes cancer development, according to new findings in eLife.

Researcher fighting breast cancer with light therapy

October 17, 2018
When treatment is working for a patient who is fighting cancer, the light at the end of the tunnel is easier to see.

New method uses just a drop of blood to monitor lung cancer treatment

October 17, 2018
Dr. Tasuku Honjo won the 2018 Nobel Prize in physiology or medicine for discovering the immune T-cell protein PD-1. This discovery led to a set of anti-cancer medications called checkpoint inhibitors, one of the first of ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.