New practice-changing research will reduce the need for major surgery in many melanoma patients

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

New research to guide clinicians to more accurately stage and manage melanoma patients
16 Nov 2017

New research to guide clinicians to more accurately stage and manage melanoma patients

New research from MIA has been published that forms the basis of the updated international guidelines for staging melanoma.

Founding father recognised for outstanding cancer care
15 Nov 2017

Founding father recognised for outstanding cancer care

Professor William McCarthy AM has been awarded the Tom Reeve Award for Outstanding Contributions to Cancer Care.

Melanoma researchers shine at the State's premier cancer awards ceremony
03 Nov 2017

Melanoma researchers shine at the State's premier cancer awards ceremony

Leading researchers from MIA have been acknowledged with three prestigious awards for excellence in melanoma research.

Enhancing melanoma treatment response through gut bacteria
03 Nov 2017

Enhancing melanoma treatment response through gut bacteria

New research shows that patients who are more likely to respond to immunotherapy treatment have a greater diversity in their gut bacteria.

Comparing melanoma risk in similar populations across different latitudes
20 Oct 2017

Comparing melanoma risk in similar populations across different latitudes

MIA's epidemiologist explains her new research on how country of residence should be considered when identifying melanoma risk.

Congratulations to our Conjoint Medical Directors
19 Oct 2017

Congratulations to our Conjoint Medical Directors

Congratulations to our Conjoint Medical Directors, Professor Georgina Long and Professor Richard Scolyer, who have today been announced as Fellows of the Australian Academy of Health and Medical Sciences.

What causes melanoma in 90% of young Australians?
19 Oct 2017

What causes melanoma in 90% of young Australians?

New research shows potentially deadly UV damage can appear decades earlier than you think.

Early lymph node check is saving lives in melanoma patients
19 Oct 2017

Early lymph node check is saving lives in melanoma patients

Early lymph node check is saving lives in melanoma patients

Congratulations to Associate Professor Anne Cust
13 Oct 2017

Congratulations to Associate Professor Anne Cust

We are pleased to announce that A/Prof Anne Cust is the new President of the Australasian Epidemiological Association.

Smoking linked to increased risk of melanoma spreading
12 Oct 2017

Smoking linked to increased risk of melanoma spreading

New research has shown that melanoma patients who smoke have an increased risk of their disease progressing compared to patients who do not smoke.

Research boost to improve outcomes for melanoma patients
11 Oct 2017

Research boost to improve outcomes for melanoma patients

More than $3.5 million in competitive funding grants have been awarded to MIA's researchers.

Highlights in melanoma research from ESMO
21 Sep 2017

Highlights in melanoma research from ESMO

The ESMO conference provided a platform for announcing a number of key melanoma research findings - including practice-changing research from MIA.

Australian researchers stopping melanoma in its tracks
11 Sep 2017

Australian researchers stopping melanoma in its tracks

Australian researchers have successfully trialled a combination of new treatments to prevent melanoma from spreading to distant organs.

Virus-antibody combo shows promise for treating advanced melanoma
08 Sep 2017

Virus-antibody combo shows promise for treating advanced melanoma

A new treatment that combines an antibody with a cancer-killing virus improves outcomes for patients with advanced melanoma, an international clinical trial has shown.

It's time to outlaw sunburn on reality TV shows - enough is enough
31 Jul 2017

It's time to outlaw sunburn on reality TV shows - enough is enough

It feels like groundhog day - another reality TV show, another batch of blatantly sunburnt contestants.

Identifying markers for optimal response
28 Jul 2017

Identifying markers for optimal response

Wouldn’t it be great if your doctor could know if you would respond to treatment before you even had it?

Global Melanoma Research Report - July
20 Jul 2017

Global Melanoma Research Report - July

In our latest research update we showcase research in survival estimates, uncover biomarkers, and reveal practice-changing research in surgery and medical oncology.

A day in the life of... Sarah Lane
14 Jul 2017

A day in the life of... Sarah Lane

Senior Clinical Trial Coordinators, like Sarah Lane, support melanoma patients throughout the clinical trial process. 

Differentiating moles from melanoma
14 Jul 2017

Differentiating moles from melanoma

Melanomas are often hard to differentiate from moles. But new technology is helping to improve accuracy of diagnosis.

Introducing SunSense Sunscreen
11 Jul 2017

Introducing SunSense Sunscreen

We are excited to announce that SunSense will proudly be an official supporter of Melanoma Institute Australia. SunSense is an Australian, family owned business.