Mayer, K. E., Hassel, J. C., Sambale, J., Erdmann, M., Sindrilaru, M.-A., Oberschmied, J., Thiem, A., Tomsitz, D., Knuever, J., Schlaak, M., Berking, C., Posch, C., Biedermann, T., & Persa, O.-D. (2026). Complete lymph node dissection versus selective lymph node extirpation in melanoma patients with nodal macrometastasis and adjuvant systemic therapy
Kristine E Mayer, Jessica C Hassel, Jannik Sambale, Michael Erdmann, Mihaela-Anca Sindrilaru, Julia Oberschmied, Alexander Thiem, Dirk Tomsitz, Jana Knuever, Max Schlaak, Carola Berking, Christian Posch, Tilo Biedermann, Oana-Diana Persa
Faculty of Medicine Vienna Sigmund Freud Private University
Technical University Munich (TUM), Heidelberg University, Comprehensive Cancer Center Erlangen – EMN, Department of Dermatology and Allergology, Department of Dermatology, Department for Dermatology and Venerology, LMU University Hospital, Department of Dermatology and Allergy, School of Dental MedicineKlinik Hietzing, Vienna Health Care Group
https://doi.org/10.1111/ddg.15967
Abstract
BACKGROUND AND OBJECTIVES: Complete lymph node dissection (CLND) is the standard of care in patients with regional nodal melanoma macrometastasis. However, evidence on surgical procedures in the era of adjuvant systemic therapies is lacking.
PATIENTS AND METHODS: This retrospective multi-center study included stage IIIB-D melanoma patients with nodal macrometastasis undergoing CLND or selective lymph node extirpation (LNE) prior to adjuvant therapy. CLND and LNE were compared regarding recurrence-free survival (RFS), nodal metastasis-free survival (NFS) and overall survival (OS).
RESULTS: 320 melanoma patients were included (median age 62; 55.5% male). Patients received PD-1 monotherapy (77.8%), targeted therapy (21.3%) or both sequentially (0.9%), as well as adjuvant radiotherapy in 40.9%. RFS and OS did not differ significantly between patients receiving CLND or LNE, while NFS was significantly prolonged following CLND (HR 0.3917; p = 0.005). After adjustment for risk factors by multivariate Cox regression, a prolonged RFS for CLND vs. LNE was found (HR 0.676; p = 0.04), but no benefit for OS. The rate of complications was significantly higher in the CLND group.
CONCLUSIONS: CLND showed no OS benefit compared to LNE, while local control was improved. CLND can be recommended in the context of adjuvant therapies, however, the increased rate of complications should be considered.