Journal Review in Surgical Oncology: Melanoma

Join the Behind the Knife Surgical Oncology Team as we discuss the PRADO and NADINA randomized control trials regarding neoadjuvant therapy in Stage III melanoma with macroscopic nodal disease!

Hosts:

Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center.

Daniel Nelson, DO, FACS (@usarmydoc24) is Surgical Oncologist/HPB surgeon at Kaiser LAMC in Los Angeles.

Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a 2ndYear Surgical Oncology fellow at MD Anderson.

Beth (Elizabeth) Barbera, MD (@elizcarpenter16) is a General Surgery physician in the United States Air Force station at RAF Lakenheath.

Joe (Joseph) Broderick, MD, MA (@joebrod5) is a General Surgery research resident between his second and third year at Brooke Army Medical Center.

Galen Gist, MD (@gistgalen) is a General Surgery research resident between his second and third year at Brooke Army Medical Center.

Learning Objectives:

- Evaluate the role of Completion Lymph Node Dissection (CLND) in patients with positive sentinel lymph nodes, specifically citing the lack of melanoma-specific survival benefit vs. the improvement in regional disease control demonstrated in the MSLT-II trial.

- Determine the appropriate surgical excision margins for primary cutaneous melanoma, comparing the outcomes of 1 cm versus 2 cm margins as analyzed in the MINT trial (Lancet 2019).

- Analyze the impact of adjuvant systemic therapy (Anti-PD1/Immunotherapy) on recurrence-free survival in patients with resected high-risk Stage III melanoma.

References:

Reijers, I.L.M., Menzies, A.M., van Akkooi, A.C.J. et al. Personalized response-directed surgery and adjuvant therapy after neoadjuvant ipilimumab and nivolumab in high-risk stage III melanoma: the PRADO trial. Nat Med 28, 1178–1188 (2022). https://doi.org/10.1038/s41591-022-01851-x

Christian U. Blank et al. Neoadjuvant nivolumab plus ipilimumab versus adjuvant nivolumab in macroscopic, resectable stage III melanoma: The phase 3 NADINA trial.. J Clin Oncol 42, LBA2-LBA2(2024). DOI:10.1200/JCO.2024.42.17_suppl.LBA2

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