Patients with high-risk, stage III melanoma have similar outcomes whether they undergo lymph node dissection upfront or receive systemic immunotherapy prior to surgery, according to research published in the European Journal of Cancer.

Researchers found a similar overall rate of complications between these treatment groups. However, patients who underwent surgery upfront had a higher rate of complications at 1-3 months after surgery. 

In this retrospective study, researchers examined data from 120 patients with high-risk stage III melanoma treated with neoadjuvant anti-PD-1 and anti-CTLA4 therapy in the OpACIN ( Identifier: NCT02437279) and OpACIN-neo (NCT02977052) trials. 

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Overall, 44 patients received neoadjuvant treatment, and 76 underwent surgery upfront. Patients who received neoadjuvant therapy were younger than those who underwent upfront surgery (mean age, 53 years vs 60 years; P =.011). 

There was no significant difference in the overall rate of complications with neoadjuvant therapy or upfront surgery — 31.8% and 36.8%, respectively (P =.578). 

However, the rate of complications at 1-3 months was significantly higher in patients who underwent upfront surgery than in those who received neoadjuvant therapy — 25% and 9.1%, respectively (P =.033). 

The rate of grade 2 adverse events was 29% in the neoadjuvant group and 37.2% in the upfront surgery group. The rate of grade 3 events was 16% and 2.3%, respectively. There were no grade 4 or 5 adverse events in either group.

Overall, there was no significant difference between the neoadjuvant group and the upfront surgery group in the rate of seroma that required aspiration — 56.8% and 57.9%, respectively (P =.908). 

However, there was a significantly higher rate of seroma aspiration in the upfront surgery group than in the adjuvant therapy group at 1-3 months — 32.9% and 15.9%, respectively (P =.043). 

There were no significant differences between the treatment groups when it came to the rate of lymphedema (P =.175), the mean duration of surgery (P =.077), and the rate of textbook outcomes (P =.889). 

These data should be interpreted with caution, according to the researchers, due to the small number of patients and the single-center nature of the study. In addition, the study did not include patients treated with single-agent therapy. 

“This study shows that the surgical outcomes for patients who underwent a lymph node dissection after neoadjuvant systemic immunotherapy or underwent upfront lymph node dissection for high-risk stage III melanoma are comparable,” the researchers concluded. “Prospective assessment of technical difficulty of surgery, reporting of complications, and duration of surgery will validate or refute these findings in the future.” 

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Zijlker LP, van der Burg SJC, Blank CU, et al. Surgical outcomes of lymph node dissections for stage III melanoma after neoadjuvant systemic therapy are not inferior to upfront surgery.Eur J Cancer. Published online March 7, 2023. doi:10.1016/j.ejca.2023.03.003