A Prospective Cohort Study of Ultrasound Surveillance of Regional Lymph Nodes in Patients with Intermediate-Risk Cutaneous Melanoma

Abstract

Background: Sentinel Node Biopsy (SNB) is the most accurate staging investigation to assess regional lymph node involvement in patients with cutaneous melanoma and determines whether they will receive adjuvant treatment. Prior to the era of effective adjuvant therapy, SNB was considered principally to be a staging investigation which gave important prognostic information. It was also considered to be of therapeutic benefit because surveillance of regional lymph node basins by clinical examination alone had been reported to result in a 3 fold higher number of lymph nodes involved by melanoma on relapse than if patients had a SNB and completion dissection at the time of the primary diagnosis. This may have resulted in worse regional control for patients undergoing clinical surveillance. We conducted a prospective study of regular clinical examination and nodal ultrasound surveillance to assess the nodal burden on relapse when compared to historical controls of patients undergoing SNB and completion dissection at the time of primary diagnosis.