![]() 1– 3 This prospective, international, randomized trial showed that the pathologic status of the sentinel node or nodes was the most important prognostic factor and that patients who underwent sentinel-node biopsy had fewer recurrences of melanoma than patients who underwent wide excision and nodal observation. ![]() The first Multicenter Selective Lymphadenectomy Trial (MSLT-I) confirmed the value of early nodal evaluation and treatment. Sentinel-lymph-node biopsy is a standard procedure in the care of appropriately selected patients with melanoma. Lymphedema was observed in 24.1% of the patients in the dissection group and in 6.3% of those in the observation group. Nonsentinel-node metastases, identified in 11.5% of the patients in the dissection group, were a strong, independent prognostic factor for recurrence (hazard ratio, 1.78 P=0.005). 77☑.5% P<0.001 by the log-rank test) these results must be interpreted with caution. The rate of disease-free survival was slightly higher in the dissection group than in the observation group (68☑.7% and 63☑.7%, respectively P=0.05 by the log-rank test) at 3 years, based on an increased rate of disease control in the regional nodes at 3 years (92☑.0% vs. In the per-protocol analysis, the mean (±SE) 3-year rate of melanoma-specific survival was similar in the dissection group and the observation group (86☑.3% and 86☑.2%, respectively P=0.42 by the log-rank test) at a median follow-up of 43 months. Immediate completion lymph-node dissection was not associated with increased melanoma-specific survival among 1934 patients with data that could be evaluated in an intention-to-treat analysis or among 1755 patients in the per-protocol analysis.
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