"I was delighted to take part in a clinical trial as it has the potential to really help others in the future.”
A study using ultrasound to examine lymph glands after having melanoma removed (SUNMEL)
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This study used an ultrasound scan to examine lymph glands around the area where a melanoma had been removed.
This study was open for people to join between 2010 and 2014. The results were published in 2019.
More about this trial
After having your melanoma removed, doctors examine the lymph glands nearest to where your melanoma was to make sure the cancer hadn’t spread. They'd feel the lymph glands to see if they had become larger or felt different. If they felt different, this could mean that melanoma had spread to these glands.
They might also remove the nearest lymph node to see if the melanoma had spread there. The nearest lymph gland is called the sentinel node. Finding and removing the sentinel node is called a sentinel node biopsy. This is a small operation that could have side effects.
Doctors are always looking for better ways of finding out if melanoma had spread to the lymph glands.
In this study they used an ultrasound scan to look at the nearby lymph glands in people who chose not to have a sentinel node biopsy. The ultrasound scan uses sound waves to look for changes in lymph glands. This involves putting some jelly on the skin over the lymph glands and passing a small device over the skin. The device sends out sound waves and receives them back. The sound waves bounce off the lymph glands and build up a picture of them on a screen.
The aim of this study was to find out if having regular ultrasound scans picked up changes in lymph glands before they were felt by hand.
Summary of results
The results suggest that it is safe to use ultrasounds in people with melanoma who are having the surrounding lymph glands checked.
About this study
After removing the melanoma everyone had an ultrasound to look at the surrounding lymph glands and then again:
- every 3 months for the 1st year
- every 4 months for the 2nd and 3rd years
- every 6 months for the 4th and 5th years
Examining the lymph glands using the ultrasound the researchers looked at:
- their location
- their size
- their shape
- their number
- the thickness of the outer edge area under the lymph glands, as this can become thicker if the melanoma has spread to the lymph gland
- whether there was any change in the amount of blood vessels in or around the lymph glands, which can also change if melanoma has spread to a lymph gland
The doctor examined everyone for signs of the melanoma coming back before they had the ultrasound.
89 people took part in this study.
The average follow up was just under 4 years (52 months).
The team looked at the number of people whose melanoma had come back. They found it had in 20 people.
For 10 of these 20 people the melanoma had spread to the lymph glands.
For 5 of these 10 people when the doctor examined them, they found no evidence of melanoma in the lymph glands. But their ultrasound showed that there were some abnormal changes. This might show a very small amount of melanoma spread that was too small for the doctor to feel.
When the researchers took a sample of tissue (biopsy) from these 5 people it confirmed there were melanoma cells in their lymph glands.
9 of the 10 people had their lymph glands removed. The number of lymph glands removed from each person was 1 or 2.
The team also looked at whether the melanoma had spread to the area around where the melanoma was but not to a lymph gland. They found that this happened to 4 of the 20 people. At the time these results were written:
- the melanoma had spread to the lymph glands in 2 people
- it hadn’t spread in 2 people and they are being watched closely
The researchers also looked at whether the melanoma had spread to another part of their body. They found this happened in 6 of the 20 people.
5 of them reported having symptoms and so had tests to investigate this.
For the remaining person their doctor felt an enlarged lymph gland on examination. When they had tests it showed the melanoma had spread a lot.
The team say these results suggest using ultrasound to check the surrounding lymph glands in combination with a doctor examining the lymph glands is safe for people with melanoma who chose not to have a sentinel node biopsy.
Where this information comes from
We have based this summary on information from the research team. The information they sent us has been reviewed by independent specialists (peer reviewed) and published in a medical journal. The figures we quote above were provided by the trial team who did the research. We have not analysed the data ourselves.
How to join a clinical trial
Dr Joseph Meirion Thomas
Dr Andrew Hayes
The Royal Marsden NHS Foundation Trust