before those trials came out, there was a much higher rate of uh completion lymph node dissection even in in kids. And then after those trials, the rate has gone down, but it's still higher than what's done uh typically in adults.
before those trials came out, there was a much higher rate of uh completion lymph node dissection even in in kids. And then after those trials, the rate has gone down, but it's still higher than what's done uh typically in adults.
I think the the answer would more likely just be to move forward with systemic therapy. Uh I don't think people would move forward with the completion lymph node at that time. You would just go with advent therapy.
I think the the answer would more likely just be to move forward with systemic therapy. Uh I don't think people would move forward with the completion lymph node at that time. You would just go with advent therapy.
BOB in Ped Surg 2023 - IPSO Winner - Steven Scoville, MD
▶Ep 2 · 3:01
quotePediatric melanoma has approximately 500 new cases diagnosed annually in children less than or equal to 18 years old.↗
▶Ep 2 · 3:01
quoteManagement of pediatric melanoma is based on adult studies.↗
▶Ep 2 · 3:01
clinicalManagement of pediatric melanoma is based on adult studies despite differences in disease mechanisms↗
▶Ep 2 · 3:01
guidelineTumors less than 8 millimeters thick are largely managed with wide local excision↗
▶Ep 2 · 3:01
guidelineTumors greater than or equal to 8 millimeters or less than 8 millimeters with high risk features without metastatic involvement typically undergo wide local excision with sentinel lymph node biopsies↗
▶Ep 2 · 3:01
clinicalTwo adult trials (Decog SLT and MSLT2) showed no significant difference in outcomes for patients with positive sentinel lymph node biopsies followed with ultrasound observation versus completion lymph node dissections↗
▶Ep 2 · 3:01
clinicalThere is no pediatric data to support ultrasound observation versus completion lymph node dissection↗
▶Ep 2 · 3:01
epidemiologicalPediatric melanoma has approximately 500 new cases diagnosed annually in children less than or equal to 18 years old↗
▶Ep 2 · 3:01
clinicalChildhood melanoma is associated with delayed diagnosis and more frequently has nodal involvement compared to adults↗
▶Ep 2 · 3:01
quotethere is no pediatric data to support one versus the other↗
▶Ep 2 · 4:10
clinicalStudy included 252 patients less than or equal to 18 years old diagnosed with cutaneous melanoma between 2010 and 2020 from 14 institutions↗
▶Ep 2 · 4:10
quotewe found nearly equal distribution of age, tumor location, while race was predominantly white, consistent with prior literature↗
▶Ep 2 · 4:10
clinicalBreslow depth ranged from 2 millimeters to 20 millimeters with a median of 2.55 millimeters↗
▶Ep 2 · 5:20
clinicalOf 227 patients who underwent wide local excision with sentinel lymph node biopsies, 115 had positive sentinel lymph node biopsies (approximately 51%)↗
▶Ep 2 · 6:30
quotethere was no significant differences between recurrence or death from disease between these two groups↗
▶Ep 2 · 6:30
clinicalThere was no significant difference in recurrence or death from disease between ultrasound observation and completion lymph node dissection groups↗
▶Ep 2 · 6:30
clinicalPatients who underwent completion lymph node dissection were significantly older and more likely to receive adjuvant therapy↗
▶Ep 2 · 7:30
quoteOnly 21% of patients that underwent completion lymph node dissection had additional nodes discovered and findings of additional nodal disease did not significantly correlate with recurrence.↗
▶Ep 2 · 7:30
clinicalRate of recurrence was not significantly different between completion lymph node dissection patients with or without additional nodal burden↗
▶Ep 2 · 7:30
clinicalOnly 21% of those who underwent completion lymph node dissection had additional positive nodal disease↗
▶Ep 2 · 7:30
clinicalPositive sentinel lymph node biopsies had significantly higher rate of disease recurrence at 18% compared to 3% for negative sentinel lymph node biopsy group↗
▶Ep 2 · 8:00
clinicalRecurrence was associated with positive nodal disease, deeper Breslow depth, greater use of adjuvant therapy, and higher rate of death↗
▶Ep 2 · 8:31
clinicalPediatric melanoma presents as advanced disease with nearly 50% positive sentinel lymph node biopsy rate↗
▶Ep 2 · 8:31
clinicalManagement of nodal disease had no significant impact on disease outcomes with respect to recurrence or death from disease↗
▶Ep 2 · 8:31
quoteRecurrence did most strongly associate with positive sentinel lymph node biopsies and deeper Breslow depth.↗
▶Ep 2 · 9:15
quotebefore those trials came out, there was a much higher rate of uh completion lymph node dissection even in in kids. And then after those trials, the rate has gone down, but it's still higher than what's done uh typically in adults.↗
▶Ep 2 · 9:15
opinionFor most children with positive sentinel lymph nodes, observation is appropriate without moving forward with completion lymph node dissection↗
▶Ep 2 · 9:15
clinicalBefore the Decog and MSLT2 trials, there was a much higher rate of completion lymph node dissection in children, and after those trials the rate has gone down but is still higher than in adults↗
▶Ep 2 · 9:15
quotewe didn't find any statistical difference between those that underwent completion lymph node dissection versus uh sentinel lymph node with um ultrasound observation↗
▶Ep 2 · 9:53
quotefor most children we can, um while the disease is thought to be more severe, you can still observe these patients with sentinel lymph nodes and not uh move forward with um completion lymph node dissection↗
▶Ep 2 · 10:45
clinicalNot all patients with positive sentinel lymph nodes receive adjuvant therapy; decision depends on genetic makeup of melanoma and overall risk factors including tumor size↗
▶Ep 2 · 11:46
opinionIf a lymph node becomes clinically positive during ultrasound surveillance, the likely approach would be to move forward with systemic therapy rather than completion lymph node dissection↗
▶Ep 2 · 12:08
quoteI think the the answer would more likely just be to move forward with systemic therapy. Uh I don't think people would move forward with the completion lymph node at that time. You would just go with advent therapy.↗
BOB in Ped Surg 2023 - IPSO Winner - Steven Scoville, MD
▶Ep 10 · 3:01
quotethere is no pediatric data to support one versus the other↗
▶Ep 10 · 3:01
epidemiologicalPediatric melanoma has approximately 500 new cases diagnosed annually in children less than or equal to 18 years old↗
▶Ep 10 · 3:01
clinicalChildhood melanoma is associated with delayed diagnosis and more frequently has nodal involvement compared to adults↗
▶Ep 10 · 3:01
clinicalManagement of pediatric melanoma is based on adult studies despite differences in disease mechanisms↗
▶Ep 10 · 3:01
guidelineTumors less than 8 millimeters thick are largely managed with wide local excision↗
▶Ep 10 · 3:01
guidelineTumors greater than or equal to 8 millimeters or less than 8 millimeters with high risk features without metastatic involvement typically undergo wide local excision with sentinel lymph node biopsies↗
▶Ep 10 · 3:01
clinicalTwo adult trials (Decog SLT and MSLT2) showed no significant difference in outcomes for patients with positive sentinel lymph node biopsies followed with ultrasound observation versus completion lymph node dissections↗
▶Ep 10 · 3:01
clinicalThere is no pediatric data to support ultrasound observation versus completion lymph node dissection↗
▶Ep 10 · 3:01
quotePediatric melanoma has approximately 500 new cases diagnosed annually in children less than or equal to 18 years old.↗
▶Ep 10 · 3:01
quoteManagement of pediatric melanoma is based on adult studies.↗
▶Ep 10 · 4:10
quotewe found nearly equal distribution of age, tumor location, while race was predominantly white, consistent with prior literature↗
▶Ep 10 · 4:10
clinicalStudy included 252 patients less than or equal to 18 years old diagnosed with cutaneous melanoma between 2010 and 2020 from 14 institutions↗
▶Ep 10 · 4:10
clinicalBreslow depth ranged from 2 millimeters to 20 millimeters with a median of 2.55 millimeters↗
▶Ep 10 · 5:20
clinicalOf 227 patients who underwent wide local excision with sentinel lymph node biopsies, 115 had positive sentinel lymph node biopsies (approximately 51%)↗
▶Ep 10 · 6:30
clinicalThere was no significant difference in recurrence or death from disease between ultrasound observation and completion lymph node dissection groups↗
▶Ep 10 · 6:30
clinicalPatients who underwent completion lymph node dissection were significantly older and more likely to receive adjuvant therapy↗
▶Ep 10 · 6:30
quotethere was no significant differences between recurrence or death from disease between these two groups↗
▶Ep 10 · 7:30
clinicalOnly 21% of those who underwent completion lymph node dissection had additional positive nodal disease↗
▶Ep 10 · 7:30
clinicalPositive sentinel lymph node biopsies had significantly higher rate of disease recurrence at 18% compared to 3% for negative sentinel lymph node biopsy group↗
▶Ep 10 · 7:30
clinicalRate of recurrence was not significantly different between completion lymph node dissection patients with or without additional nodal burden↗
▶Ep 10 · 7:30
quoteOnly 21% of patients that underwent completion lymph node dissection had additional nodes discovered and findings of additional nodal disease did not significantly correlate with recurrence.↗
▶Ep 10 · 8:00
clinicalRecurrence was associated with positive nodal disease, deeper Breslow depth, greater use of adjuvant therapy, and higher rate of death↗
▶Ep 10 · 8:31
clinicalPediatric melanoma presents as advanced disease with nearly 50% positive sentinel lymph node biopsy rate↗
▶Ep 10 · 8:31
quoteRecurrence did most strongly associate with positive sentinel lymph node biopsies and deeper Breslow depth.↗
▶Ep 10 · 8:31
clinicalManagement of nodal disease had no significant impact on disease outcomes with respect to recurrence or death from disease↗
▶Ep 10 · 9:15
clinicalBefore the Decog and MSLT2 trials, there was a much higher rate of completion lymph node dissection in children, and after those trials the rate has gone down but is still higher than in adults↗
▶Ep 10 · 9:15
quotewe didn't find any statistical difference between those that underwent completion lymph node dissection versus uh sentinel lymph node with um ultrasound observation↗
▶Ep 10 · 9:15
quotebefore those trials came out, there was a much higher rate of uh completion lymph node dissection even in in kids. And then after those trials, the rate has gone down, but it's still higher than what's done uh typically in adults.↗
▶Ep 10 · 9:15
opinionFor most children with positive sentinel lymph nodes, observation is appropriate without moving forward with completion lymph node dissection↗
▶Ep 10 · 9:53
quotefor most children we can, um while the disease is thought to be more severe, you can still observe these patients with sentinel lymph nodes and not uh move forward with um completion lymph node dissection↗
▶Ep 10 · 10:45
clinicalNot all patients with positive sentinel lymph nodes receive adjuvant therapy; decision depends on genetic makeup of melanoma and overall risk factors including tumor size↗
▶Ep 10 · 11:46
opinionIf a lymph node becomes clinically positive during ultrasound surveillance, the likely approach would be to move forward with systemic therapy rather than completion lymph node dissection↗
▶Ep 10 · 12:08
quoteI think the the answer would more likely just be to move forward with systemic therapy. Uh I don't think people would move forward with the completion lymph node at that time. You would just go with advent therapy.↗
