V54: Implementation Outcomes for Active Surveillance with Ultrasound (U/S) Following a Positive Sentinel Lymph Node (SLN) in Melanoma at an Academic Medical Center

Monday, February 28, 2022

5:13 PM – 5:16 PM CST

Location: Zoom Meeting

Virtual Poster Presenter(s)

Michael S. Sabel, MD, FACS, FSSO

Professor of Surgery
University of Michigan
Ann Arbor, Michigan, United States

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Participants should be aware of the following financial/non-financial relationships:

Michael S. Sabel, MD, FACS, FSSO: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Introduction: A melanoma active surveillance clinic for SLN-positive patients electing observation over node dissection was started, to include baseline and yearly CT/MRI and regional U/S per MSLT2. We examined adherence to U/S surveillance.

Methods:

A prospective melanoma database was queried for patients with a positive SLN from 1/18 to 9/20. Chart review was performed for treatment, methods for surveillance and outcomes.

Results:

Among 289 patients with a positive SLN, 13 patients (4.5%) were excluded for stage IV disease on staging and 77 (28%) had a node dissection, leaving 197 patients. Adjuvant therapy included targeted therapy in 8% and immunotherapy in 13%. Of 197 pts planning surveillance, 159 (80%) had the first 4 month U/S. 1 for stage IV, 1 developed pancreatic cancer and 2 died. 23 patients transferred to outside oncologists; 3 used U/S, 5 used q6 month CT scans, 3 used yearly CT only and 13 cases were unknown. 6 patients opted out, 3 for insurance issues. With a mean f/u of 1.75yrs, 134 (84%) adhered to U/S surveillance including 46 patients where surveillance was d/c for recurrence or death. 25 (16%) stopped prematurely; 7 chose to stop (2 quoting insurance issues), 10 transferred locally with no U/S or switching to CT and 7 were lost to follow-up. Among patients who initiated surveillance, 28/159 (17%) developed a regional recurrence, 26 in the basin and 2 in the pelvis after a positive inguinal SLN. 11 (42%) were detected with U/S, 12 on exam and 5 on CT or PET. 9 had simultaneous distant disease. Of the remaining 19, 10 remain disease free after treatment while 9 developed distant disease within a year. 18/159 (11%) patients developed distant disease in the absence of regional recurrence.

Conclusions:

A melanoma active surveillance clinic yielded excellent adherence to ultrasound surveillance, but some patients failed to initiate or adhere to surveillance. Challenges included loss or change in insurance, travel burdens, and lack of coordination with outside oncologists. Information on recurrence patterns, including method of detection, may help tailor surveillance strategies to further improve adherence.

Learning Objectives:

Upon completion, participants will identify barriers to ultrsaound surveillance following a positive sentinel lymph node biopsy in melanoma.
Upon completion, participant will be able to describe recurrence patterns in patients on ultrasound surveillance.
Upon completion, participant will be able to understand surveillance gaps between surgical oncologists and medical oncologists.