1092 Impact Of MSLT-II on Lymph Node Clearance Surgery in A Tertiary Plastic Surgery Centre

Abstract

Abstract Aim Cutaneous malignant melanoma is a significant public health challenge in the United Kingdom. Wide local excision with Sentinel Lymph Node Biopsy (SLNB) is the current standard of treatment for most lesions. Some patients with positive SLNB would routinely undergo locoregional Lymph Node Clearance (LNC). Results of the Multicenter Selective Lymphadenectomy Trial II (MSLT-II) published in August 2017 challenged this approach, showing no melanoma specific survival benefit, but significant morbidity associated with routine LNC. Our study aims to show a change in practice at a tertiary plastic surgical referral centre in response to these results. Method We retrospectively reviewed our prospectively maintained database for all LNCs performed for cutaneous, non-head and neck malignant melanoma using the search terms ‘clearance’ and ‘dissection’ between 2015 and 2019. Results We performed 128 axillary and groin LNCs for cutaneous malignant melanoma 2015-2019. The range of LNCs per year varied from 38 in 2015 to 10 in 2019 (mean 25.6, median 28). The total number of LNCs, as well as LNCs performed following positive SLNB decreased after August 2017. Conclusions The data shows that our centre acknowledged evidence and reduced the number of LNCs performed after publication of MSLT-II. We expect that the number of avoided LNCs has saved significant resources due to reduced length of stay, and avoided our patient’s significant morbidity, including seromas, infections and lymphoedema. We recommend all skin cancer treatment centres to follow the evidence in order to provide excellent care and save resources.