skip to main content

Melanoma — SCE Dermatology MCQ

Instant feedback + full explanation. One question, done properly.

HardSkin CancerMelanomaSCE Dermatology

A 55-year-old man with melanoma has a positive sentinel lymph node biopsy. The node contains a micrometastasis (largest deposit 0.5 mm). According to current evidence, should completion lymph node dissection be performed?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — No — completion lymph node dissection is no longer routinely recommended based on MSLT-II and DeCOG-SLT trial data

The correct answer is A, No: completion lymph node dissection is no longer routinely recommended based on MSLT-II and DeCOG-SLT trial data. Both randomised trials showed that immediate completion lymph node dissection after a positive sentinel lymph node biopsy (SLNB) does not improve melanoma-specific survival compared with active nodal ultrasound surveillance, despite giving more regional disease control information. This applies directly to this patient, whose sentinel node contains only a micrometastasis (0.5 mm), the exact population studied in MSLT-II. NICE NG14 has incorporated this evidence and advises against routine completion dissection for stage III micrometastatic disease detected by SLNB, favouring surveillance with ultrasound plus consideration of adjuvant systemic therapy based on stage.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/skin-conditions