NTTS 2017

Since the introduction of this procedure in 1992, many trials were conducted to assessed its staging and therapeutic role. Initially the procedure was analyzed to test the safety and efficacy in the short and long term outcome, if it is at least as effective and/or safe as existing proven techniques and to verify the prognostic role and the prognostic factors correlated to the outcome. The first Multicenter Selective Lymphadenectomy Trial (MSLT-I), comparing the procedure followed by immediate complete lymph node dissection in positive patients with observation only. For intermediate-thickness or thick primary melanomas provided important prognostic information and identified patients with nodal metastases who may benefit from immediate complete lymphadenectomy.Sunbelt Melanoma Trial showed that adjuvant high dose Interferon did not improve survival in patients with a single tumor positive sentinel node and was not adequately powered to detect small differences in disease-free and overall survival. The trial offered important information about technical aspect of the sentinel procedure and prognostic factors correlated with the disease outcome. Sentinel lymph node (SLN) biopsy is now a standard staging procedure for melanoma but the value of completion lymph node dissection (CLND) for patients with SLN metastases is not clear and needs to be clarified. More recently DeCog trial, from German groups, despite a very short follow-up leading to the trial being underpowered, showed no difference in overall survival in patients with positive sentinel node treated with complete lymph node dissection compared with observation only. In this trial some limitations about the prognostic factors of the primary and the sentinel node reducing “a priori” the usefulness of CLND must be considered. Data from MSLT II trial are not yet available, but the time from study design and final results may represents a bias to lead the clinical interpretation. The changing in staging system and prognostic factors analyzed may lead again to underpowered the trial to identify those subgroups of patients that may benefit of an early nodal dissection. The sentinel procedure provides an accurate and important information and in absence of MSLT II trial result, for positive sentinel node cases CLND remains the best opportunity to discuss with the patients.