Research presented this week at the 9th World Congress of Melanoma supports the updated guideline recommendation that sentinel lymph node biopsy be performed in more patients newly diagnosed with melanoma, as it has the potential to save lives due to the information the procedure provides.
This biopsy, which looks for cancer cells in the lymph nodes, can identify patients whose melanoma has spread beyond the site on the skin (Stage III melanoma) and who may be suitable to receive the new generation of anti-melanoma drugs.
The recently published Australian Clinical Practice Guidelines for the Diagnosis and Management of Melanoma recommends that “sentinel lymph node biopsy should be considered for all patients with melanoma greater than 1 mm in thickness and for patients with melanoma greater than 0.8 mm with other high risk pathological features to provide optimal staging and prognostic information and to maximise management options for patients who are node positive”.
“We know patients who have melanoma cells present in their draining lymph nodes (Stage III) are up to three times more likely to die from their melanoma than patients where the lymph nodes are clear,” says David Gyorki, a consultant surgeon and melanoma specialist at the Peter MacCallum Cancer Centre.
“For some time, we’ve known that sentinel lymph node biopsy is an excellent way to identify those patients who have a higher risk of having their disease progress, and with the new drugs we have gained the tools to respond and to reduce this risk.
“On the horizon, we will have access to effective, well tolerated drug therapies that can reduce the risk of relapse and, using sentinel lymph node biopsy to identify appropriate patients, the data indicate that this strategy is saving lives.”
For most patients diagnosed with melanoma, their disease is localised and effectively treated with surgery; however, some patients’ disease will progress. Of the 14,000 Australians diagnosed with melanoma each year, almost 15% will die from their disease.
Findings from recent clinical trials have demonstrated a major improvement in survival for patients with Stage III melanoma using drug therapy after surgery with the aim to prevent the melanoma from appearing in distant organs (Stage IV disease).
In one such clinical trial, known as COMBI-AD, patients who received a combination of targeted therapies (dabrafenib and trametinib) decreased the chance of their melanoma progressing by 53% compared to the current standard therapy of ‘watch and wait’.
“We encourage clinicians to inform their patients about sentinel lymph node biopsy so that patients can properly understand their risk of recurrence and death from melanoma, and therefore discuss the option of further drug therapy” says Professor Georgina Long, Medical Oncologist and Co-Medical Director of Melanoma Institute Australia.
The 9th World Congress of Melanoma is underway in Brisbane, October 18 – 21.