Is therapeutic lymph node dissection of value for lymph node recurrence in melanoma?

Background: Therapeutic lymphadenectomy (TLND) is still performed in most melanoma patients to treat nodal recurrences after initial negative lymph node biopsy (-SLNB), despite the lack of evidence for survival benefit. We sought to compare melanoma-specific survival (MSS) and distant metastasis-free survival (DMFS) of patients who underwent TLND versus no TLND using our institutional and MSTL-1 databases. Methods: We identified 146 patients with nodal recurrence following -SLNB: 132 underwent TLND and 14 did not. DMFS and MSS were evaluated for the cohorts followed by a matched-pair analysis between the cohorts. Results: No difference was observed in five-year DMFS (p = 0.454) and five-year MSS (p = 0.945) between the two groups. The matched-pair analysis showed similar results (p = 0.329 and p = 0.363 for DMSF and MSS, respectively). Conclusions: From this limited retrospective study, TLND for nodal recurrence after a -SLNB does not appear to improve DMFS or MSS in melanoma patients compared to no TLND.