skip to main content

MSLT-II CLND — SCE Medical Oncology MCQ

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

HardMelanoma & SkinMSLT-II CLNDSCE Medical Oncology

A 55-year-old man with melanoma asks about sentinel node biopsy after the MSLT-II trial results. MSLT-II showed that completion lymph node dissection (CLND) after positive SLNB did NOT improve melanoma-specific survival compared with observation + ultrasound surveillance. What changed in practice?

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

Reveal the answer and explanation

Correct answer: E — Use protocolled nodal ultrasound surveillance rather than routine completion dissection

MSLT-II changed practice from routine completion lymph-node dissection to structured nodal-basin ultrasound surveillance after a positive sentinel node. Use nodal ultrasound surveillance after completion dissection for macrometastatic deposits: surveillance is used instead of routine completion dissection, not after it. Use nodal-basin radiotherapy instead of completion dissection for each positive node: routine basin radiotherapy was not the universal replacement strategy. Use whole-body PET-CT surveillance instead of completion dissection every three months: the relevant observation strategy uses focused nodal ultrasound. Use clinical palpation surveillance instead of completion dissection every three months: palpation alone is less sensitive than protocolled nodal ultrasound.

Reference: NICE NG14 melanoma: recommendations (Updated July 2022; minor amendment January 2024): https://www.nice.org.uk/guidance/ng14/chapter/recommendations