Adjuvant therapies for high risk Melanoma - Surgical Management

First speaker (Van Akkooi) discusses the surgical management for high risk melanoma




Wide Local Excision (WLE)

Findings:

• Haydu (2016): Difference only in Relapse Free Survival (RFS) when pT2 and comparing both arms in table above. No difference in Overall Survival (OS) however.
• Thomas (2004): Difference in Locoregional recurrence when comparing 1cm to 3 cm WLE (3cm is off course better than 1 cm)
• Hayes (2016), which is same dataset as Thomas (2004) but now longer follow up: Differences in Melanoma Specific Survival (MSS), again difference in OS is not sigificant

Is Sentinel Node Biopsy (SNB) of therapeutic value, or prognostic value?

According to Van Akkooi, the data supports the claim that SNB Positive (yellow line) and Observation with nodal recurrence (orange) have a significantly different Melanoma-Specific Survival. One could suggest that having a positive SNB is preferential compared to haven't executed a SNB and observe a nodal recurrence later. 

Adjuvant Ipilimumab: 20% relapse free survival benefit for Ipi adjuvant after CLND.

When looking to the Subgroups : positive SN (effect is highest) vs. palpable node

Most effect of Adjuvant Ipi : positive SN with ulcerated primary Melanoma

Van Akkooi is convinced no Complete Lymph Node Dissections (CLND) will be executed in the future unless one relapses. Instead of CLND => Adjuvant Therapy (e.g. Ipi) when Sentinel Node Biopsy positive.