A real-world study shows major treatment centres across the world are increasingly and successfully using active surveillance rather than surgery to manage sentinel lymph nodes in cutaneous melanoma.

Australia has been an enthusiastic adopter, with patients at three leading centres being the least likely to undergo completion lymph node dissection (CLND) compared with those at 18 other centres in Europe and the US.

The move away from CLND is a response to two pivotal trials (The German Dermatologic Co-operative Oncology Group Study, DeCOG-SLT and The Second Multicentre Lymphadenectomy Trial, MSLT-2) published in 2016 and 2017, respectively.

Both trials, which included more than 2400 patients in total, showed that active ultrasound surveillance of a positive sentinel lymph node (SLN) gave equivalent survival outcomes to CLND and there was increased lymphoedema with surgery.