Evaluation of Clinical Outcomes and Pattern of Recurrence in Patients with Cutaneous Melanoma and Sentinel Lymph Node Positivity Since the Publication of the MSLT-2 Trial
- Author(s)
- Mor, E; Apte, S; Bressel, M; Broman, KK; Hieken, TJ; Olofsson Bagge, R; Berman, RS; Lee, AY; Kuijpers, AM; Ollila, DW; van Akkooi, ACJ; Zager, JS; Gyorki, DE;
- Journal Title
- Annals of Surgical Oncology
- Publication Type
- Online publication before print
- Abstract
- BACKGROUND: Sentinel lymph node biopsy (SLNB) is recommended as a staging tool for some patients with primary melanoma to select for adjuvant therapy. This study investigates the impact of adjuvant immunotherapy on recurrence patterns in patients managed with nodal surveillance (NS). PATIENTS AND METHODS: A multicenter, retrospective analysis was performed, including patients with SLN-positive melanoma who were followed with NS. Outcomes were 5-year recurrence-free survival (RFS) and overall survival (OS). Factors associated with recurrence were evaluated using Cox proportional hazards models. RESULTS: A total of 544 patients were treated at 10 centers across Australia, Europe, and the USA from 2017 to 2023. Adjuvant immunotherapy was given in 235 (43%) patients. Patients who received adjuvant immunotherapy had melanomas at higher risk of recurrence (higher Breslow thickness p < 0.001, higher rates of ulceration p = 0.003, and higher SLN tumor burden p < 0.001). Among patients receiving adjuvant immunotherapy, the 5-year cumulative incidence of nodal, in-transit, and distant recurrence were 25% (95% CI 18-32%), 6% (95% CI 3-9%) and 19% (95% CI 14-26%), respectively. In the multivariable analysis, factors associated with recurrence included older age, higher stage, cervical nodal basin and larger nodal burden, while adjuvant therapy was associated with a lower risk of recurrence (HR 0.7, 95% CI 0.5-0.9). CONCLUSIONS: Adjuvant immunotherapy was given in higher risk patients and reduced the risk of recurrence. Given the significant mismatch in patient populations between treated and untreated groups, it was not possible to assess for a treatment-related effect on pattern of recurrence. There is, however, a clear stage-related difference in recurrence pattern among patients with sentinel node positive disease.
- Department(s)
- Surgical Oncology
- Publisher's Version
- https://doi.org/10.1245/s10434-026-19260-6
- Open Access at Publisher's Site
https://doi.org/10.1245/s10434-026-19260-6- Terms of Use/Rights Notice
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Creation Date: 2026-03-10 04:07:04
Last Modified: 2026-03-10 04:07:14