scholarly journals Melanoma nodal management in Ontario the year after the 2012 American Society of Clinical Oncology and Society of Surgical Oncology guideline

2019 ◽  
Vol 26 (5) ◽  
Author(s):  
S. Latosinsky ◽  
B. Allen ◽  
S. Z. Shariff
Keyword(s):  
Lymph Node ◽  
Clinical Oncology ◽  
Cutaneous Melanoma ◽  
Surgical Oncology ◽  
The United States ◽  
Lymph Node Biopsy ◽  
Administrative Databases ◽  
Guideline Recommendation ◽  
Ontario Cancer Registry ◽  
American Society

Background In 2012 in the United States, the American Society of Clinical Oncology and the Society of Surgical Oncology (asco/sso) published a joint guideline about indications for sentinel lymph node biopsy (slnb) in cutaneous melanoma. The guideline supported completion lymph node dissection (clnd) for all patients with positive sentinel nodes. We examined the rates and predictors of slnb and clnd for melanoma patients in Ontario (population 13.6 million) after publication of that guideline.Methods We used the Ontario Cancer Registry to identify patients diagnosed with cutaneous melanoma in 2013. Patient records were linked to prospectively maintained health administrative databases to obtain details for each patient, including surgical procedures.Results Of the 3298 patients with melanoma identified in Ontario in 2013, 1973 (59.8%) could be analyzed. Most of that group (n = 1227, 62.2%) underwent local excision alone; 746 (37.8%) had a slnb. The slnb was performed in 13.9%, 67.8%, 62.6%, and 47.2% of patients with T1, T2, T3, and T4 primary melanomas respectively. In multivariate analysis, receipt of slnb was positively associated with younger age (<80 years), higher T stage, and a non-head-andneck primary. Of the patients who had a slnb, 136 (18.2%) were found to be node-positive. A clnd was performed in 82 of those patients (60.3%).Conclusions In Ontario, only two thirds of patients with intermediate-thickness melanomas (T2, T3) underwent slnb as recommended by the asco/sso guideline. Use of slnb was less frequent for patients with a head-and-neck primary and higher for younger patients (<80 years). The rate of clnd after a positive slnb was also low relative to the guideline recommendation.

Melanoma nodal management in Ontario following ASCO/SSO guidelines.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e21054-e21054
Author(s):  
Steven Latosinsky ◽  
Salimah Shariff ◽  
Britney Allen
Keyword(s):  
Lymph Node ◽  
Head And Neck ◽  
Cutaneous Melanoma ◽  
Surgical Oncology ◽  
Lymph Node Biopsy ◽  
Administrative Databases ◽  
Ontario Cancer Registry ◽  
Younger Age ◽  
Melanoma Patients ◽  
American Society

e21054 Background:Methods:Results: Conclusions:The American Society of Clinical Oncology and Society of Surgical Oncology (ASCO/SSO) published a joint guideline in 2012 regarding indications for sentinel lymph node biopsy (SLNB) in cutaneous melanoma. The guideline supported completion lymph node dissection (CLND) for all patients with a positive SLNB. We examined the rates and predictors of SLNB and CLND for melanoma patients in Ontario (population 13.6 million) following guideline publication. Methods: We used the Ontario Cancer Registry (OCR) to identify cutaneous melanoma patients diagnosed in 2013. Patient records were linked to prospectively maintained health administrative databases to obtain details for each patient including surgical procedures. Results: We identified 3298 melanoma patients from Ontario in 2013 of which 1,973 (59.8%) could be analyzed. The majority, 1,227 (62.2%) had a local excision alone, while 746 (37.8%) had a SLNB. SLNB was performed on T1, T2, T3 and T4 primary melanomas in 13.9%, 67.8%, 62.6% and 47.2% of cases respectively. Receipt of a SLNB was positively associated with a younger age (< 80), higher T stage, and non-head and neck primary in multivariate analysis. Of the patients who received a SLNB 136 (18.2%) were found to be node positive. A CLND was performed in 82 (60.3%) of these patients. Conclusions: In Ontario only two-thirds of intermediate thickness melanomas (T2, T3) received a SLNB as recommended by the ASCO/SSO guidelines. Utilization was lower for head and neck patients and higher for younger (< 80 years) patients. Use of CLND for positive SLNB was also low relative to the guidelines.

Sentinel Lymph Node Biopsy and Management of Regional Lymph Nodes in Melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Clinical Practice Guideline Update

2018 ◽  
Vol 36 (4) ◽  
pp. 399-413 ◽  
Author(s):  
Sandra L. Wong ◽  
Mark B. Faries ◽  
Erin B. Kennedy ◽  
Sanjiv S. Agarwala ◽  
Timothy J. Akhurst ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Clinical Oncology ◽  
Surgical Oncology ◽  
Breslow Thickness ◽  
Clinicopathological Factors ◽  
Careful Observation ◽  
Randomized Controlled ◽  
Potential Benefits ◽  
American Society

Purpose To update the American Society of Clinical Oncology (ASCO)-Society of Surgical Oncology (SSO) guideline for sentinel lymph node (SLN) biopsy in melanoma. Methods An ASCO-SSO panel was formed, and a systematic review of the literature was conducted regarding SLN biopsy and completion lymph node dissection (CLND) after a positive sentinel node in patients with melanoma. Results Nine new observational studies, two systematic reviews, and an updated randomized controlled trial of SLN biopsy, as well as two randomized controlled trials of CLND after positive SLN biopsy, were included. Recommendations Routine SLN biopsy is not recommended for patients with thin melanomas that are T1a (nonulcerated lesions < 0.8 mm in Breslow thickness). SLN biopsy may be considered for thin melanomas that are T1b (0.8 to 1.0 mm Breslow thickness or < 0.8 mm Breslow thickness with ulceration) after a thorough discussion with the patient of the potential benefits and risk of harms associated with the procedure. SLN biopsy is recommended for patients with intermediate-thickness melanomas (T2 or T3; Breslow thickness of > 1.0 to 4.0 mm). SLN biopsy may be recommended for patients with thick melanomas (T4; > 4.0 mm in Breslow thickness), after a discussion of the potential benefits and risks of harm. In the case of a positive SLN biopsy, CLND or careful observation are options for patients with low-risk micrometastatic disease, with due consideration of clinicopathological factors. For higher-risk patients, careful observation may be considered only after a thorough discussion with patients about the potential risks and benefits of foregoing CLND. Important qualifying statements outlining relevant clinicopathological factors and details of the reference patient populations are included within the guideline. Additional information is available at www.asco.org/melanoma-guidelines and www.asco.org/guidelineswiki .

scholarly journals Sentinel Lymph Node Biopsy for Melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Joint Clinical Practice Guideline

2012 ◽  
Vol 30 (23) ◽  
pp. 2912-2918 ◽  
Author(s):  
Sandra L. Wong ◽  
Charles M. Balch ◽  
Patricia Hurley ◽  
Sanjiv S. Agarwala ◽  
Timothy J. Akhurst ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Disease Control ◽  
Clinical Oncology ◽  
Surgical Oncology ◽  
Breslow Thickness ◽  
Newly Diagnosed ◽  
Evidence Review ◽  
Regional Disease ◽  
American Society

Purpose The American Society of Clinical Oncology (ASCO) and Society of Surgical Oncology (SSO) sought to provide an evidence-based guideline on the use of lymphatic mapping and sentinel lymph node (SLN) biopsy in staging patients with newly diagnosed melanoma. Methods A comprehensive systematic review of the literature published from January 1990 through August 2011 was completed using MEDLINE and EMBASE. Abstracts from ASCO and SSO annual meetings were included in the evidence review. An Expert Panel was convened to review the evidence and develop guideline recommendations. Results Seventy-three studies met full eligibility criteria. The evidence review demonstrated that SLN biopsy is an acceptable method for lymph node staging of most patients with newly diagnosed melanoma. Recommendations SLN biopsy is recommended for patients with intermediate-thickness melanomas (Breslow thickness, 1 to 4 mm) of any anatomic site; use of SLN biopsy in this population provides accurate staging. Although there are few studies focusing on patients with thick melanomas (T4; Breslow thickness, > 4 mm), SLN biopsy may be recommended for staging purposes and to facilitate regional disease control. There is insufficient evidence to support routine SLN biopsy for patients with thin melanomas (T1; Breslow thickness, < 1 mm), although it may be considered in selected patients with high-risk features when staging benefits outweigh risks of the procedure. Completion lymph node dissection (CLND) is recommended for all patients with a positive SLN biopsy and achieves good regional disease control. Whether CLND after a positive SLN biopsy improves survival is the subject of the ongoing Multicenter Selective Lymphadenectomy Trial II. Copyright © 2012 American Society of Clinical Oncology and Society of Surgical Oncology. All rights reserved. No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission by the American Society of Clinical Oncology and Society of Surgical Oncology.

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