Biopsy-Based Management Better for Melanomas
Biopsy-Based Management Better for Melanoma
(HealthDay News) — Sentinel-node biopsy-based management of primary cutaneous melanomas is associated with improved long-term outcomes, according to a study published in the Feb. 13 issue of the New England Journal of Medicine.
Donald L. Morton, MD, from the Saint John's Health Center in Santa Monica, CA, and colleagues assessed outcomes for 2,001 patients with primary cutaneous melanomas. The patients were randomly assigned to undergo wide excision and nodal observation, with lymphadenectomy for nodal relapse (observation group), or wide excision and sentinel-node biopsy, with immediate lymphadenectomy for biopsy-detected nodal metastases (biopsy group).
The researchers found that in the overall study population there was no significant treatment-related difference in the 10-year melanoma-specific survival rate.
Among patients with intermediate-thickness melanomas (1.20 to 3.50 mm) and thick melanomas (>3.50 mm), the mean 10-year disease-free survival rates were significantly improved in the biopsy group versus the observation group (hazard ratios [HR] for recurrence or metastasis, 0.76 and 0.70, respectively).
The 10-year melanoma-specific survival rate was significantly lower for those with versus without metastasis for intermediate thickness melanomas (HR for death from melanoma, 3.09) and thick melanomas (HR, 1.75). For patients with intermediate-thickness melanomas and nodal metastases, biopsy-based management correlated with improved 10-year distant disease-free survival (HR for distant metastasis, 0.62) and 10-year melanoma-specific survival (HR for death from melanoma, 0.56).
"These long-term results clearly validate the use of sentinel-node biopsy in patients with intermediate-thickness or thick primary melanomas," the researchers wrote.
In an accompanying editorial, Charles M. Balch, MD, of the Texas Southwester Medical Center in Dallas, TX, and Jeffrey E. Gershenwald, MD, of the University of Texas MD Anderson Cancer Center in Houston, TX, discussed the clinical implications of the trial.
"Although the article by Morton and colleagues did not explore the role of sentinel-node biopsy among patients with thin melanomas (<1 mm), the identification of patients with thin melanomas who have moderate risk of tumor-involved sentinel nodes is an area of current investigation," they wrote.
"This practice-changing trial shows the important role of early identification and surgical removal of regional metastases, both in obtaining staging information and in improving survival in defined cohorts of patients with melanoma."
Several authors disclosed financial ties to the pharmaceutical and biotechnology industries; one author holds a patent on the molecular classification of melanoma which has been licensed to Myriad Genetics.