A trial comparing surgery to remove lymph nodes with no further surgery for people with melanoma (MSLT II)

Cancer type:

Melanoma

Skin cancer

Status:

Results

Phase:

Phase 3

This trial compared treatment for people who have had a lymph node removed that contained melanoma.

The trial was open for people to join between 2004 and 2014. The team published the results in 2017.

More about this trial

Doctors usually treat melanoma with surgery. They often remove the lymph node nearest to the area of melanoma as well. This node is called the sentinel lymph node. They check whether this lymph node contains any cancer cells.

If there are melanoma cells in the sentinel node, the doctors will remove the other lymph nodes in that area. But removing all the lymph nodes can cause side effects.

When this trial was done, doctors weren’t sure whether it was best to remove all the lymph nodes straight away or not.

This trial was for people who had cancer cells in the sentinel node that had been removed. Some people went on to have surgery to remove all their lymph nodes. And some people didn’t. Those who didn’t have surgery had regular ultrasound scans.

The aims of this trial were to:

find out if it is better for people to have their lymph nodes removed or not
compare the side effects of each type of treatment

Summary of results

The research team found that it was not better to remove all the nearby lymph nodes in people who have melanoma in their sentinel node.

Trial design
This trial was for people who:

had already had surgery to remove their melanoma
had melanoma cells in the sentinel lymph node which was removed during the operation

Nearly 2,000 people joined the trial. They were put into a treatment group at random:

971 had further surgery to remove their lymph nodes
968 didn’t have surgery to remove their lymph nodes

Diagram 1

The people who didn’t have surgery straight away had regular ultrasound scans. They had surgery if there were any signs of cancer in the lymph nodes on a scan.

Results
The research team looked at how many people were living, 3 years after they joined the trial. They found it was:

nearly 9 out of 10 people (86%) in both groups

They also looked at how many people didn’t have any signs of melanoma, 3 years after they joined the trial. They found this was:

nearly 7 out of 10 (68%) for those who had surgery straight away
more than 6 out of 10 (63%) for those who didn’t have surgery

Bar Chart 1

Side effects
Surgery to remove lymph nodes can cause fluid to build up in a part of the body close to the operation site. This swelling is called lymphoedema. It affected:

more than 2 out of 10 people (24%) who had surgery straight away
less than 1 out of 10 people (6%) who didn’t have surgery straight away

Conclusion
The trial team concluded that removing lymph nodes soon after initial surgery does not help people live longer. This is for people whose sentinel lymph node contained melanoma cells.

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 Open a glossary item ) 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.