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Management of Melanoma Patients with Positive Nodes

      Melanoma patients with positive nodes can be subdivided into 3 categories: (1) those with clinically positive nodes at initial presentation, (2) those with clinically positive nodal recurrence, and (3) those with positive node(s) on sentinel lymph node biopsy.

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      References

        • Balch C.M.
        • Soong S.J.
        • Gershenwald J.E.
        • et al.
        Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system.
        J Clin Oncol. 2001; 19: 3622-3634
        • Gershenwald J.E.
        • Scolyer R.A.
        Melanoma staging: American Joint Committee on Cancer (AJCC) 8th edition and beyond.
        Ann Surg Oncol. 2018; 25: 2105-2110
        • Haydu L.E.
        • Scolyer R.A.
        • Lo S.
        • et al.
        Conditional survival: an assessment of the prognosis of patients at time points after initial diagnosis and treatment of locoregional melanoma metastasis.
        J Clin Oncol. 2017; 35: 1721-1729
        • Diller M.L.
        • Martin B.M.
        • Delman K.A.
        Lymph node dissection for stage III melanoma.
        Surg Oncol Clin N Am. 2015; 24: 261-277
        • Guggenheim M.M.
        • Hug U.
        • Jung F.J.
        • et al.
        Morbidity and recurrence after completion lymph node dissection following sentinel lymph node biopsy in cutaneous malignant melanoma.
        Ann Surg. 2008; 247: 687-693
        • McMasters K.M.
        • Noyes R.D.
        • Reintgen D.S.
        • et al.
        Lessons learned from the Sunbelt Melanoma Trial.
        J Surg Oncol. 2004; 86: 212-223
        • Morton D.L.
        • Cochran A.J.
        • Thompson J.F.
        • et al.
        Sentinel node biopsy for early-stage melanoma: accuracy and morbidity in MSLT-I, an international multicenter trial.
        Ann Surg. 2005; 242 ([discussion: 311–03]): 302-311
        • Bartlett E.K.
        Current management of regional lymph nodes in patients with melanoma.
        J Surg Oncol. 2019; 119: 200-207
        • National Comprehensive Cancer Network
        NCCN clinical practice guidelines in oncology: cutaneous melanoma version 2.2019.
        (Available at:) (Accessed December 2, 2019)
        • Stodell M.
        • Thompson J.F.
        • Emmett L.
        • et al.
        Melanoma patient imaging in the era of effective systemic therapies.
        Eur J Surg Oncol. 2017; 43: 1517-1527
        • Xing Y.
        • Bronstein Y.
        • Ross M.I.
        • et al.
        Contemporary diagnostic imaging modalities for the staging and surveillance of melanoma patients: a meta-analysis.
        J Natl Cancer Inst. 2011; 103: 129-142
        • Pezner R.D.
        • Patterson M.P.
        • Hill L.R.
        • et al.
        Arm lymphedema in patients treated conservatively for breast cancer: relationship to patient age and axillary node dissection technique.
        Int J Radiat Oncol Biol Phys. 1986; 12: 2079-2083
        • Tominaga T.
        • Takashima S.
        • Danno M.
        Randomized clinical trial comparing level II and level III axillary node dissection in addition to mastectomy for breast cancer.
        Br J Surg. 2004; 91: 38-43
        • Gentile D.
        • Covarelli P.
        • Picciotto F.
        • et al.
        Axillary lymph node metastases of melanoma: management of third-level nodes.
        In Vivo. 2016; 30: 141-145
        • Mahvi D.A.
        • Fairweather M.
        • Yoon C.H.
        • et al.
        Utility of level III axillary node dissection in melanoma patients with palpable axillary lymph node disease.
        Ann Surg Oncol. 2019; 26: 2846-2854
        • Nessim C.
        • Law C.
        • McConnell Y.
        • et al.
        How often do level III nodes bear melanoma metastases and does it affect patient outcomes?.
        Ann Surg Oncol. 2013; 20: 2056-2064
        • Oude Ophuis C.M.
        • van Akkooi A.C.
        • Hoekstra H.J.
        • et al.
        Risk factors for positive deep pelvic nodal involvement in patients with palpable groin melanoma metastases: can the extent of surgery be safely minimized? : A retrospective, multicenter cohort study.
        Ann Surg Oncol. 2015; 22: S1172-S1180
        • Strobbe L.J.
        • Jonk A.
        • Hart A.A.
        • et al.
        The value of Cloquet's node in predicting melanoma nodal metastases in the pelvic lymph node basin.
        Ann Surg Oncol. 2001; 8: 209-214
        • Badgwell B.
        • Xing Y.
        • Gershenwald J.E.
        • et al.
        Pelvic lymph node dissection is beneficial in subsets of patients with node-positive melanoma.
        Ann Surg Oncol. 2007; 14: 2867-2875
        • Karakousis C.P.
        • Driscoll D.L.
        • Rose B.
        • et al.
        Groin dissection in malignant melanoma.
        Ann Surg Oncol. 1994; 1: 271-277
        • Pasquali S.
        • Mocellin S.
        • Bigolin F.
        • et al.
        Pelvic lymph node status prediction in melanoma patients with inguinal lymph node metastasis.
        Melanoma Res. 2014; 24: 462-467
        • Andersen P.S.
        • Chakera A.H.
        • Thamsborg A.K.
        • et al.
        Recurrence and survival after neck dissections in cutaneous head and neck melanoma.
        Dan Med J. 2014; 61: A4953
        • Kroon H.M.
        • van der Bol W.D.
        • Tonks K.T.
        • et al.
        Treatment of Clinically Positive Cervical Lymph Nodes by Limited Local Node Excision and Adjuvant Radiotherapy in Melanoma Patients with Major Comorbidities.
        Ann Surg Oncol. 2018; 25: 3476-3482
        • Henderson M.A.
        • Burmeister B.H.
        • Ainslie J.
        • et al.
        Adjuvant lymph-node field radiotherapy versus observation only in patients with melanoma at high risk of further lymph-node field relapse after lymphadenectomy (ANZMTG 01.02/TROG 02.01): 6-year follow-up of a phase 3, randomised controlled trial.
        Lancet Oncol. 2015; 16: 1049-1060
        • Jones E.L.
        • Jones T.S.
        • Pearlman N.W.
        • et al.
        Long-term follow-up and survival of patients following a recurrence of melanoma after a negative sentinel lymph node biopsy result.
        JAMA Surg. 2013; 148: 456-461
        • O'Connell E.P.
        • O'Leary D.P.
        • Fogarty K.
        • et al.
        Predictors and patterns of melanoma recurrence following a negative sentinel lymph node biopsy.
        Melanoma Res. 2016; 26: 66-70
        • Thomas D.C.
        • Han G.
        • Leong S.P.
        • et al.
        Recurrence of melanoma after a negative sentinel node biopsy: predictors and impact of recurrence site on survival.
        Ann Surg Oncol. 2019; 26: 2254-2262
        • Wagner J.D.
        • Ranieri J.
        • Evdokimow D.Z.
        • et al.
        Patterns of initial recurrence and prognosis after sentinel lymph node biopsy and selective lymphadenectomy for melanoma.
        Plast Reconstr Surg. 2003; 112: 486-497
        • Zogakis T.G.
        • Essner R.
        • Wang H.J.
        • et al.
        Natural history of melanoma in 773 patients with tumor-negative sentinel lymph nodes.
        Ann Surg Oncol. 2007; 14: 1604-1611
        • Faries M.B.
        • Thompson J.F.
        • Cochran A.J.
        • et al.
        Completion dissection or observation for sentinel-node metastasis in melanoma.
        N Engl J Med. 2017; 376: 2211-2222
        • Kretschmer L.
        • Bertsch H.P.
        • Zapf A.
        • et al.
        Nodal Basin Recurrence After Sentinel Lymph Node Biopsy for Melanoma: A Retrospective Multicenter Study in 2653 Patients.
        Medicine (Baltimore). 2015; 94: e1433
        • Barbour S.
        • Mark Smithers B.
        • Allan C.
        • et al.
        Patterns of Recurrence in Patients with Stage IIIB/C Cutaneous Melanoma of the Head and Neck Following Surgery With and Without Adjuvant Radiation Therapy: Is Isolated Regional Recurrence Salvageable?.
        Ann Surg Oncol. 2015; 22: 4052-4059
        • Jakub J.W.
        • Racz J.M.
        • Hieken T.J.
        • et al.
        Neoadjuvant systemic therapy for regionally advanced melanoma.
        J Surg Oncol. 2018; 117: 1164-1169
        • Amaria R.N.
        • Prieto P.A.
        • Tetzlaff M.T.
        • et al.
        Neoadjuvant plus adjuvant dabrafenib and trametinib versus standard of care in patients with high-risk, surgically resectable melanoma: a single-centre, open-label, randomised, phase 2 trial.
        Lancet Oncol. 2018; 19: 181-193
        • Buzaid A.C.
        • Colome M.
        • Bedikian A.
        • et al.
        Phase II study of neoadjuvant concurrent biochemotherapy in melanoma patients with local-regional metastases.
        Melanoma Res. 1998; 8: 549-556
        • Gibbs P.
        • Anderson C.
        • Pearlman N.
        • et al.
        A phase II study of neoadjuvant biochemotherapy for stage III melanoma.
        Cancer. 2002; 94: 470-476
        • Lewis K.D.
        • Robinson W.A.
        • McCarter M.
        • et al.
        Phase II multicenter study of neoadjuvant biochemotherapy for patients with stage III malignant melanoma.
        J Clin Oncol. 2006; 24: 3157-3163
        • Moschos S.J.
        • Edington H.D.
        • Land S.R.
        • et al.
        Neoadjuvant treatment of regional stage IIIB melanoma with high-dose interferon alfa-2b induces objective tumor regression in association with modulation of tumor infiltrating host cellular immune responses.
        J Clin Oncol. 2006; 24: 3164-3171
        • Tarhini A.A.
        • Lin Y.
        • Lin H.M.
        • et al.
        Expression profiles of immune-related genes are associated with neoadjuvant ipilimumab clinical benefit.
        Oncoimmunology. 2017; 6: e1231291
        • Amaria R.N.
        • Reddy S.M.
        • Tawbi H.A.
        • et al.
        Neoadjuvant immune checkpoint blockade in high-risk resectable melanoma.
        Nat Med. 2018; 24: 1649-1654
        • Blank C.U.
        • Rozeman E.A.
        • Fanchi L.F.
        • et al.
        Neoadjuvant versus adjuvant ipilimumab plus nivolumab in macroscopic stage III melanoma.
        Nat Med. 2018; 24: 1655-1661
        • Liu J.Y.
        • Lowe M.
        Neoadjuvant treatments for advanced resectable melanoma.
        J Surg Oncol. 2019; 119: 216-221
        • Long G.V.
        • Saw R.P.M.
        • Lo S.
        • et al.
        Neoadjuvant dabrafenib combined with trametinib for resectable, stage IIIB-C, BRAF(V600) mutation-positive melanoma (NeoCombi): a single-arm, open-label, single-centre, phase 2 trial.
        Lancet Oncol. 2019; 20: 961-971
        • Amaria R.N.
        • Menzies A.M.
        • Burton E.M.
        • et al.
        Neoadjuvant systemic therapy in melanoma: recommendations of the International Neoadjuvant Melanoma Consortium.
        Lancet Oncol. 2019; 20: e378-e389
        • Wong S.L.
        • Faries M.B.
        • Kennedy E.B.
        • et al.
        Sentinel lymph node biopsy and management of regional lymph nodes in melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Clinical Practice Guideline Update.
        Ann Surg Oncol. 2018; 25: 356-377
        • Morton D.L.
        • Thompson J.F.
        • Cochran A.J.
        • et al.
        Sentinel-node biopsy or nodal observation in melanoma.
        N Engl J Med. 2006; 355: 1307-1317
        • McMasters K.M.
        • Egger M.E.
        • Edwards M.J.
        • et al.
        Final results of the sunbelt melanoma trial: a multi-institutional prospective randomized phase III study evaluating the role of adjuvant high-dose interferon alfa-2b and completion lymph node dissection for patients staged by sentinel lymph node biopsy.
        J Clin Oncol. 2016; 34: 1079-1086
        • Delman K.A.
        • Wong S.L.
        Completion node dissection after sentinel node biopsy in melanoma.
        JAMA Surg. 2018; 153: 1045-1046
        • Bello D.M.
        • Faries M.B.
        The landmark series: MSLT-1, MSLT-2 and DeCOG (management of lymph nodes).
        Ann Surg Oncol. 2020; 27: 15-21