Practice Patterns of Surveillance in Sentinel Lymph Node-Positive Malignant Melanoma​​​: An International Survey.

Abstract

Objectives: To understand surveillance practice patterns in melanoma patients with a positive sentinel lymph node (SLN) biopsy.

Methods: A survey was designed, tested for item relevance, readability, and content validity, and subsequently distributed to melanoma surgeons through institutional emails and international societies.

Results: Majority of the 59 respondents were <10 years from training (59.3%), in academia (74.1%), or dedicated >25% of their practice to melanoma (50.8%). Nearly all surgeons (98.3%) would not recommend complete lymph node dissection (CLND) for a 2 mm melanoma with nodal metastasis <1 mm. 79.7% of surgeons claim a significant role in determining the surveillance regimen, and most (57.6%) opt for a combination of nodal basin ultrasound and CT or PET/CT, while 39.0% follow with ultrasound only. No difference in surveillance modality was seen when stratifying time since training (≤10 vs. >10 y; P=0.798). However, for those who dedicate >25% of their practice to melanoma, significantly fewer surgeons report use of ultrasound only (>25%: 13.3% vs. ≤25%: 65.5%; P<0.001). Whereas 33.9% of surgeons state their surveillance strategy is agnostic to patient factors, others claim adherence to appointments (30.5%), distance from hospital (18.9%), and insurance (15.8%) shift their management. Breslow depth >4 mm (27.4%), ulceration (22.2%), and mapping to >1 basin (16.2%) are the most common reasons surgeons obtain cross-sectional imaging. Reasons that deter surgeons against ultrasound as the surveillance modality of choice include reproducibility/interpretation of the results (42.6%), patient preference (25.0%), and medical oncology preference (22.1%).

Conclusions: Despite trials aimed to inform the management of SLN-positive melanoma, surveillance strategies remain largely dependent on provider preference and individual patient factors.