Richard L. Shapiro, MD, associate professor, Department of Surgery, NYU Langone Health’s Perlmutter Cancer Center, discusses the utility of complete lymph node dissection (cLND) in melanoma.

cLND has been the subject of international studies for decades in patients with melanoma, says Shapiro.

Data from the ​phase 3 MSLT-II trial, along with those from a German study, have demonstrated that ​patients who have microscopic disease in the sentinel lymph nodes do not benefit from cLND, explains Shapiro.

Conversely, patients who have bulky disease in the lymph nodes do achieve a survival advantage​ from cLND, including decreased local rates ​of recurrence. ​However, proper patient selection is critical, Shapiro concludes.

Videos

Richard L. Shapiro, MD, discusses the utility of complete lymph node dissection in melanoma.

 Dr. Shapiro on the Utility of Complete Lymph Node Dissection in Melanoma 

Richard L. Shapiro, MD, associate professor, Department of Surgery, NYU Langone Health’s Perlmutter Cancer Center, discusses the surgical management of advanced-stage melanoma.

Most surgeons say that surgical resectability is a state of mind and that, “almost anything is resectable,” says Shapiro. One question that arises when managing advanced-stage melanoma is how to best serve the patient. Over the years, surgeons have become more cosmetically sensitive to the needs of the patient in terms of surgical resectability. Radical resections have a very small role in the management of melanoma in the modern era, Shapiro adds.

When surgery is likely going to be challenging and/or disfiguring, surgeons now have effective agents that may work in the neoadjuvant setting, such as immunotherapy. Today, patients have more treatment options than they previously had available. Surgeons have to be aware of these newer options in order for the patient to get the best result, concludes Shapiro.

Richard L. Shapiro, MD, discusses the surgical management of advanced-stage melanoma.
 

Dr. Shapiro on the Surgical Management of Advanced-Stage Melanoma

Richard L. Shapiro, MD, associate professor, Department of Surgery, New York University Langone Medical Center, discusses recent advancements related to surgery in the field of melanoma.

Regardless of systemic, therapeutic advancements, melanoma is predominantly a surgical disease, and 95% of patients are able to be cured with surgery alone, Shapiro explains. Practitioners usually think about the treatment of melanoma surgically in 3 different categories. One is the treatment of the primary melanoma, the second is the treatment of the lymph nodes, and the third is the treatment of metastatic melanoma to other sites, he adds.

Melanoma is different than other skin cancers and mostly different from other tumors in that it has the ability to spread very aggressively locally and to form satellite metastases around it. One hundred years ago, Shapiro says, surgeons took 10- to 15-centimeter margins around melanomas because they thought that melanoma spreads very broadly along the underlying [fascial] planes. However, studies show that this is not how melanoma spreads. There have been many prospective randomized studies conducted to determine how narrow surgeons can get when removing a melanoma so that the surgery is not disfiguring to the patient.

Richard L. Shapiro, MD

Articles

Dr. Shapiro on the Utility of Complete Lymph Node Dissection in Melanoma

Dr. Shapiro on the Surgical Management of Advanced-Stage Melanoma

Dr. Shapiro on Surgical Advancements in Field of Melanoma