New practice-changing research will reduce the need for major surgery in many melanoma patients
9 June 2017
New findings from a large international clinical trial published in the New England Journal of Medicine this week are likely to change the way melanoma is managed in many patients by reducing the need for major surgery and its associated morbidity and cost. Many Australian patients participated in this trial, and Melanoma Institute Australia was the top recruiting centre in the world.
National and international melanoma management guidelines currently state that patients who are found to have melanoma deposits in a “sentinel” lymph node should undergo immediate completion lymph node clearance — a large operation that removes all remaining lymph nodes in the area (the axilla, the groin or the neck).
However, the initial results of the second Multicenter Selective Lymphadenectomy Trial (MSLT-II) indicate that there is no difference in survival for sentinel-node positive patients who undergo immediate lymph node clearance compared to those who are closely monitored with ultrasound to detect disease progression. The three-year melanoma-specific survival was 86±1.3% in 824 patients who had a completion lymph node dissection versus 86±1.2% in 931 patients who were monitored, after a median follow up of 43 months.
“These results are going to change treatment recommendations for sentinel-node positive patients, most of whom will avoid the short-term and long-term morbidity that may follow a complete lymph node dissection,” said co-author and Senior Surgeon at Melanoma Institute Australia, Professor John Thompson AO. “Only those who are found to have disease in their lymph nodes during the course of follow-up — about 20% — will ultimately require full regional lymph node dissection. This change in treatment recommendation is likely to improve the quality of life for many patients around the world.” In particular, this will make a big difference to patients who have disease of the lower limb, by reducing the rate of a common complication, lymphoedema.
Although immediate lymph node clearance in sentinel-node positive patients will no longer be recommended, an initial sentinel lymph node biopsy — a minor procedure able to be performed at the same time as wide excision of the primary melanoma site — will still be required to provide accurate staging and guide treatment planning, as well as to provide a reliable estimate of prognosis.
Although no significant survival benefit was achieved by immediate completion lymph node dissection, the authors noted that the procedure did provide some potential benefits for patients with melanoma, including improved staging which can help identify high-risk patients. As well, it provides information that may be required for inclusion in medical oncology clinical trials of new medical therapies, and improves regional disease control.
“The management of regional lymph nodes has long been controversial in the treatment of many solid tumours, particularly melanoma,” noted Professor Thompson. “But this trial provides robust evidence to change the current practice guidelines to improve our management of patients with melanoma.”
Publication: Faries MB, Thompson JF, Cochran AJ, et al. Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma. N Engl J Med 2017; 376:2211-2222
In our latest research update we showcase research in survival estimates, uncover biomarkers, and reveal practice-changing research in surgery and medical oncology.
Senior Clinical Trial Coordinators, like Sarah Lane, support melanoma patients throughout the clinical trial process.
Melanomas are often hard to differentiate from moles. But new technology is helping to improve accuracy of diagnosis.
We are excited to announce that SunSense will proudly be an official supporter of Melanoma Institute Australia. SunSense is an Australian, family owned business.
Five years ago Julie Randall was diagnosed with melanoma and was given months to live. The melanoma had spread throughout her body. The doctors said it was incurable and she’d be lucky if she survived the next nine months. Julie, a patient at Melanoma Institute Australia under Professor Georgina Long was placed on an experimental drug trial. To watch the entire program, visit 9now.com or click here.
Meet our latest Surgical Oncology Fellow, Eva Nagy, to find out more about life as a surgical oncologist, why she came to MIA and what she hopes to achieve.
Melanoma research at ASCO this year focussed on the more precise use of current treatments to ensure optimal treatment for each patient.
MIA recently demonstrated that reflectance confocal microscopy is a useful tool in the clinic to diagnose suspicious-looking lesions in the mouth.
The full-day symposium is for participants with an interest in translational research.
New research is likely to change the way melanoma is managed in many patients by reducing the need for major surgery and its associated morbidity and cost.
Researchers from MIA will present their latest research findings to the world’s largest oncology conference in early June.
Australian researchers pioneer life-extending treatment for advanced melanoma patients with brain tumours
Australian researchers are the first to demonstrate that patients with advanced melanoma which has spread to the brain can have increased life expectancy and possibly even beat the disease.
Melanoma March 2017 - that's a wrap! Thank you to everyone that helped make it happen.
Thank you so much to all those who contributed in a variety of ways to Melanoma March 2017 in 17 different locations and more around the country! You have contributed to getting the Big Data for Melanoma national Research Project happening!
By looking at the ‘dark matter’ of the genome, new research has found that genetic changes in acral and mucosal melanoma are completely different to mutations found in skin melanoma.
‘Slip, slop, slap’ is synonymous with being Australian and playing it safe in the sun. These sun smart rules reduce our chances of getting melanoma of the skin. However, new research tells a different story for those affected by rarer forms of melanoma.
Using MIA's patient database, researchers have developed conditional survival estimates for Stage III melanoma patients to more accurately predict survival outcomes.
MIA is proud to be celebrating an important milestone – the 60th anniversary of melanoma research and Australian-led global efforts to find a cure.
Research achievements by MIA were celebrated at the annual Sydney Medical School recently.