{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T02:27:56Z","timestamp":1740104876975,"version":"3.37.3"},"reference-count":12,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,5,8]],"date-time":"2024-05-08T00:00:00Z","timestamp":1715126400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Objectives<\/jats:title><jats:p>MSLT\u20102 and DECOG\u2010SLT established that immediate complete axillary lymph node dissection (CLND) did not correlate with an increase in melanoma\u2010specific survival when compared with active ultrasound observation in patients with sentinel lymph node\u00a0(SLN)\u2010positive\u00a0disease. After those trials, there was a shift toward\u00a0performing CLND only for clinically node\u2010positive disease. With these changes, we sought to determine the role of level III axillary lymph nodes in bulky disease and how the use of neoadjuvant therapy may impact the rate of positivity in level III axillary nodes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a retrospective chart review on all patients who underwent axillary CLND for cutaneous melanoma by one surgeon at an academic center from 2014 to 2022. These patients underwent CLND based on either having SLN+ disease or having clinically palpable or radiographically bulky disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 95 patients included, there were 7 (7.3%) patients with level III positivity. One was SLN+ (1.0%), while 3 (3.1%) had bulky disease and neoadjuvant therapy, and 3 (3.1%) had bulky disease without neoadjuvant therapy. No preoperative factors were identified that predicted level III involvement. After performing CLND, the patients who had clinically palpable or radiographically bulky disease and neoadjuvant therapy had higher percent necrosis of nodes in levels I and II but not III.\u00a0At 5 years, overall survival and recurrence\u2010free survival were improved in those without level III involvement (58%\u00a0and 64%, respectively) when compared to those with level III involvement (41% and\u00a050%), though this was not statistically significant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Further study may identify better prognostic factors for level III positivity, allowing for the possibility of dissecting only levels I and II or even replacing CLND with targeted node dissections.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jso.27664","type":"journal-article","created":{"date-parts":[[2024,5,9]],"date-time":"2024-05-09T05:18:56Z","timestamp":1715231936000},"page":"1515-1520","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating the role of level 3 axillary lymph node dissection in metastatic melanoma: Can we predict involvement?"],"prefix":"10.1002","volume":"129","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9022-2560","authenticated-orcid":false,"given":"Lily M.","family":"Parker","sequence":"first","affiliation":[{"name":"USF Health, Morsani College of Medicine Tampa Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kate E.","family":"Beekman","sequence":"additional","affiliation":[{"name":"USF Health, Morsani College of Medicine Tampa Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danielle K.","family":"DePalo","sequence":"additional","affiliation":[{"name":"Department of Cutaneous Oncology Moffitt Cancer Center Tampa Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly M.","family":"Elleson","sequence":"additional","affiliation":[{"name":"Department of Cutaneous Oncology Moffitt Cancer Center Tampa Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6886-4468","authenticated-orcid":false,"given":"Jonathan S.","family":"Zager","sequence":"additional","affiliation":[{"name":"USF Health, Morsani College of Medicine Tampa Florida USA"},{"name":"Department of Cutaneous Oncology Moffitt Cancer Center Tampa Florida 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