Sentinel lymph node biopsy in melanoma: Redundant in the neoadjuvant era
In brief
Skipping sentinel node biopsy improves distant metastasis-free survival by up to 19%
A decision-analysis using trial data showed that patients who forgo sentinel lymph node biopsy and receive neoadjuvant anti-PD-1 plus anti-CTLA-4 therapy at nodal recurrence achieve an 8 to 19 percentage-point gain in distant metastasis-free survival compared with the traditional biopsy-then-adjuvant-immunotherapy pathway. The benefit varies with tumor thickness, prompting calls for a randomized trial to confirm whether SLNB can be safely omitted in modern melanoma care.
- Journal
- European journal of cancer (Oxford, England : 1990) (Q1)
- Published
- 10 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Antonius W Schurink, Josephine C Janssen, Peter L van Hulst, Hester F Lingsma, Cornelis Verhoef, Dirk J Grünhagen
- PMID
- 42748588
- DOI
- 10.1016/j.ejca.2026.117038
Why clinicians should know about it
- Picked for Dermatology (top studies of the week, 20 September 2026): Sentinel lymph node biopsy relevance in melanoma era
- Picked for Surgical Oncology (top studies of the week, 20 September 2026): Model suggests SLNB omission may improve outcomes
Abstract
BACKGROUND: Neoadjuvant immunotherapy has emerged as a superior strategy to adjuvant immunotherapy for patients with resectable, clinically detectable stage III melanoma, significantly improving event-free survival. In microscopic stage III disease, adjuvant immunotherapy is generally considered standard of care, although lack of survival benefit prompts re-evaluation of this sentinel lymph node biopsy (SLND) plus adjuvant therapy approach. Specifically, omission of SLNB may not only spare patients from surgery but also facilitate more effective systemic therapy, reduce the required number of immunotherapy doses, and potentially improve long-term oncological outcomes. METHODS: Data from pivotal melanoma immunotherapy trials and MSLT-1 trail were used to model two clinical scenarios: (1) SLNB followed by adjuvant immunotherapy in patients with a positive sentinel lymph node, and (2) omission of SLNB and clinical observation. A subsequent nodal recurrence then treated using neoadjuvant anti-PD-1 plus anti-CTLA-4 immunotherapy. Distant metastasis-free survival (DMFS) was simulated using a Markov model. FINDINGS: Omission of SLNB with treatment of nodal recurrence using neoadjuvant combination immunotherapy resulted in a 8-19 percentage point improvement in DMFS compared with the SLNB strategy followed by adjuvant immunotherapy in patients with a positive sentinel lymph node. The magnitude of benefit varied according to Breslow thickness. INTERPRETATION: Omitting SLNB may improve oncological outcomes in patients with melanoma in the era of neoadjuvant immunotherapy. These findings provide a compelling rationale for an international randomized controlled trial to re-evaluate the role of SLNB within contemporary melanoma treatments.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.