ATHENS, Greece — Real-world data confirm that complete nodal dissection following a positive sentinel lymph node biopsy in patients with stage III melanoma and micrometastases does not significantly reduce the risk for relapse or death.
The retrospective study showed that adjuvant therapy — either targeted therapy or immunotherapy — halved the risk for relapse in these patients, with or without nodal dissection.
This relapse reduction, however, did not translate into improved overall survival, said Gabriele Roccuzzo, MD, a clinical dermatologist at the University of Turin, Turin, Italy, who reported the results at the 11th World Congress of Melanoma (WCM) and 21st EADO Congress 2025.
Complete nodal dissection was previously considered the standard of care in patients with stage III melanoma. Clinical practice started changing after results from three randomized clinical trials — MSLT-1 and MSLT-2, and DeCOG-SLT — that showed no benefit of the procedure for recurrence or overall survival outcomes in this patient population.
Following recent US Food and Drug Administration approvals for targeted anti-BRAF/anti-MEK inhibitors dabrafenib and trametinib and immunotherapy agents nivolumab and pembrolizumab, these therapies have been incorporated into standard of care treatment for stage III melanoma.
But “clinical trials differ from real-life scenarios,” Roccuzzo said. This led Roccuzzo and colleagues to compare the use of complete nodal dissection with immunotherapy or targeted therapies in patients with stage III disease.
The single-center retrospective study analyzed data from 157 patients with stage III melanoma and micrometastases treated between 2017 and 2022, exploring outcomes between those who underwent complete nodal dissection (88 patients) and those who did not (69 patients).
Baseline clinical features were largely similar between the groups regarding sex, melanoma site (trunk most common), and histological subtype (superficial spreading most common). However, the groups differed significantly in adjuvant therapy uptake and timing.
Over 97% of patients who did not receive nodal dissection received adjuvant therapy compared with 75% of patients who did undergo dissection. After accounting for potential biases, researchers evaluated relapse-free survival and overall survival across both groups.
The study revealed that nodal dissection did not significantly reduce the risk for relapse or death. Median relapse-free survival was 49 months for patients without nodal dissection compared with 51 months among those who underwent the procedure (hazard ratio [HR], 0.9; 95% CI, 0.37-2.22). Similarly, overall survival at 4 years was approximately 80% in both groups (P = .463).
Adjuvant therapy emerged as a significant protective factor against relapse, halving the risk, irrespective of nodal dissection (adjusted HR, 0.46). Among the 73 patients treated with targeted therapy, 25% relapsed (n = 18), and among the 60 who received immunotherapy, 33% relapsed (n = 20), with the difference not reaching statistical significance (P = .270).
This real-world study reinforces the importance of adjuvant therapy in modern melanoma management, Roccuzzo concluded.
Roland Kaufmann, MD, who was not involved in the research, explained that this real-world study does confirm earlier results from the "game-changing" MSLT-I, MSKT-II, and DeCOG-SLT trials. The new analysis showed that complete nodal dissection in this patient population "offers no melanoma-specific survival benefit" and should not be standard management, Kaufmann, head of the Department of Dermatology, Venereology and Allergology at University Hospital Frankfurt, Germany, told Medscape Medical News.
Roccuzzo reported no disclosures relevant to this presentation. Kaufmann reported disclosures with several companies, including AbbVie, AstraZeneca, and Roche.
Manuela Callari is a freelance science journalist specializing in human and planetary health. Her work has been published in The Medical Republic, Rare Disease Advisor, The Guardian, MIT Technology Review, and others.