{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T13:52:09Z","timestamp":1792245129733,"version":"4.4.0"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001774","name":"The University of Sydney","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001774","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Ann Surg Oncol"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Neoadjuvant immunotherapy for resectable stage III melanoma has demonstrated promising outcomes in recent trials, prompting a change in clinical practice in many countries. Although therapeutic lymph node dissection (TLND) remains the standard of care after neoadjuvant treatment, a less invasive index lymph node (ILN)-guided approach has been proposed. The global melanoma community\u2019s acceptance of neoadjuvant immunotherapy and the need for TLND or ILN after this remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A two-stage international survey was conducted among melanoma experts between May 2023 and January 2025. Respondents were asked about their familiarity with neoadjuvant trials, current practices, and opinions on ILN versus TLND before and after publication of the NADINA trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The response rates were 50% (118\/237) in the first survey and 62% (148\/237) in the second survey. In the second survey, 74% of the respondents considered neoadjuvant therapy the standard of care, and support for ILN-guided surgery rose from 27 to 40% between the surveys. However, 54% still favored a phase 3 randomized controlled trial before changing the clinical practice guidelines, and only 27% believed the current data were sufficient for adoption of ILN as standard. Key barriers included concerns about oncologic safety, pathologic standardization, and patient selection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The current evidence supports the use of neoadjuvant immunotherapy as the standard of care for stage III melanoma. However, widespread clinical adoption of ILN-guided surgical de-escalation remains limited. A multicenter phase 3 trial (MSLT-3), launching in 2025, is expected to provide important data to guide future practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1245\/s10434-025-18475-3","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T17:19:45Z","timestamp":1760462385000},"page":"2571-2578","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["International Survey on Evidence for Index Lymph Node Surgery After Neoadjuvant Systemic Therapy for Stage III Melanoma"],"prefix":"10.1245","volume":"33","author":[{"given":"Elan","family":"Novis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mervi","family":"Rautalin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodabe N.","family":"Amaria","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo A.","family":"Ascierto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian U.","family":"Blank","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark B.","family":"Faries","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk J.","family":"Grunhagen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David E.","family":"Gyorki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Hayes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anke M. J.","family":"Kuijpers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgina V.","family":"Long","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua M. V.","family":"Mammen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander M.","family":"Menzies","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merrick I.","family":"Ross","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Rutkowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hussein A.","family":"Tawbi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T.","family":"Tetzlaff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan S.","family":"Zager","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer A.","family":"Wargo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina J.","family":"Hieken","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3262-6935","authenticated-orcid":false,"given":"Alexander C. J.","family":"van Akkooi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"and on behalf of The International Neoadjuvant Melanoma Consortium (INMC)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,14]]},"reference":[{"key":"18475_CR1","first-page":"472","volume":"67","author":"JE Gershenwald","year":"2017","unstructured":"Gershenwald JE, Scolyer RA, Hess KR, et al. Melanoma staging: evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017;67:472\u201392.","journal-title":"CA Cancer J Clin"},{"key":"18475_CR2","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1056\/NEJMoa2211437","volume":"388","author":"SP Patel","year":"2023","unstructured":"Patel SP, Othus M, Chen Y, et al. Neoadjuvant-adjuvant or adjuvant-only pembrolizumab in advanced melanoma. N Engl J Med. 2023;388:813\u201323.","journal-title":"N Engl J Med."},{"key":"18475_CR3","doi-asserted-by":"crossref","unstructured":"Blank CU, Lucas MW, Scolyer RA, et al. Neoadjuvant nivolumab and ipilimumab in resectable stage III melanoma. N Engl J Med. 2024;391(18):1696\u20131708.","DOI":"10.1056\/NEJMoa2402604"},{"key":"18475_CR4","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.annonc.2024.11.006","volume":"36","author":"T Amaral","year":"2025","unstructured":"Amaral T, Ottaviano M, Arance A, et al. Cutaneous melanoma: ESMO clinical practice guideline for diagnosis, treatment, and follow-up. Ann Oncol. 2025;36:10\u201330.","journal-title":"Ann Oncol."},{"key":"18475_CR5","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/S1470-2045(24)00627-2","volume":"26","author":"A Hauschild","year":"2025","unstructured":"Hauschild A, Garbe C, Ascierto PA, et al. Neoadjuvant or perioperative therapy for melanoma metastasis in clinical practice: an international survey. Lancet Oncol. 2025;26:12\u20134.","journal-title":"Lancet Oncol."},{"key":"18475_CR6","doi-asserted-by":"publisher","first-page":"1310","DOI":"10.1038\/s41591-023-02336-1","volume":"29","author":"C Garbe","year":"2023","unstructured":"Garbe C, Dummer R, Amaral T, et al. Neoadjuvant immunotherapy for melanoma is now ready for clinical practice. Nat Med. 2023;29:1310\u20132.","journal-title":"Nat Med."},{"key":"18475_CR7","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1016\/j.ejso.2016.06.407","volume":"43","author":"JA Moody","year":"2017","unstructured":"Moody JA, Ali RF, Carbone AC, et al. Complications of sentinel lymph node biopsy for melanoma: a systematic review of the literature. Eur J Surg Oncol. 2017;43:270\u20137.","journal-title":"Eur J Surg Oncol."},{"key":"18475_CR8","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1016\/j.ejso.2006.10.032","volume":"33","author":"AC van Akkooi","year":"2007","unstructured":"van Akkooi AC, Bouwhuis MG, van Geel AN, et al. Morbidity and prognosis after therapeutic lymph node dissections for malignant melanoma. Eur J Surg Oncol. 2007;33:102\u20138.","journal-title":"Eur J Surg Oncol."},{"key":"18475_CR9","doi-asserted-by":"publisher","first-page":"2211","DOI":"10.1056\/NEJMoa1613210","volume":"376","author":"MB Faries","year":"2017","unstructured":"Faries MB, Thompson JF, Cochran AJ, et al. Completion dissection or observation for sentinel-node metastasis in melanoma. N Engl J Med. 2017;376:2211\u201322.","journal-title":"N Engl J Med."},{"key":"18475_CR10","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1080\/0284186X.2021.1905175","volume":"60","author":"CA Gjorup","year":"2021","unstructured":"Gjorup CA, Dahlstroem K, Hendel HW, et al. Factors associated with melanoma-related limb lymphoedema. Acta Oncol. 2021;60:779\u201384.","journal-title":"Acta Oncol."},{"key":"18475_CR11","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1001\/jamasurg.2021.7554","volume":"157","author":"ILM Reijers","year":"2022","unstructured":"Reijers ILM, Rawson RV, Colebatch AJ, et al. Representativeness of the index lymph node for total nodal basin in pathologic response assessment after neoadjuvant checkpoint inhibitor therapy in patients with stage III melanoma. JAMA Surg. 2022;157:335\u201342.","journal-title":"JAMA Surg."},{"key":"18475_CR12","doi-asserted-by":"publisher","first-page":"1178","DOI":"10.1038\/s41591-022-01851-x","volume":"28","author":"ILM Reijers","year":"2022","unstructured":"Reijers ILM, Menzies AM, van Akkooi ACJ, et al. Personalized response-directed surgery and adjuvant therapy after neoadjuvant ipilimumab and nivolumab in high-risk stage III melanoma: the PRADO trial. Nat Med. 2022;28:1178\u201388.","journal-title":"Nat Med."},{"key":"18475_CR13","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1002\/bjs.11168","volume":"106","author":"B Schermers","year":"2019","unstructured":"Schermers B, Franke V, Rozeman EA, et al. Surgical removal of the index node marked using magnetic seed localization to assess response to neoadjuvant immunotherapy in patients with stage III melanoma. Br J Surg. 2019;106:519\u201322.","journal-title":"Br J Surg."},{"key":"18475_CR14","doi-asserted-by":"publisher","first-page":"1861","DOI":"10.1093\/annonc\/mdy226","volume":"29","author":"MT Tetzlaff","year":"2018","unstructured":"Tetzlaff MT, Messina JL, Stein JE, et al. Pathological assessment of resection specimens after neoadjuvant therapy for metastatic melanoma. Ann Oncol. 2018;29:1861\u20138.","journal-title":"Ann Oncol."},{"key":"18475_CR15","doi-asserted-by":"publisher","first-page":"766","DOI":"10.1016\/j.annonc.2021.03.006","volume":"32","author":"RV Rawson","year":"2021","unstructured":"Rawson RV, Adhikari C, Bierman C, et al. Pathological response and tumour bed histopathological features correlate with survival following neoadjuvant immunotherapy in stage III melanoma. Ann Oncol. 2021;32:766\u201377.","journal-title":"Ann Oncol."},{"key":"18475_CR16","doi-asserted-by":"publisher","first-page":"3694","DOI":"10.1245\/s10434-021-11236-y","volume":"29","author":"ACJ van Akkooi","year":"2022","unstructured":"van Akkooi ACJ, Hieken TJ, Burton EM, et al. Neoadjuvant systemic therapy (NAST) in patients with melanoma: surgical considerations by the International Neoadjuvant Melanoma Consortium (INMC). Ann Surg Oncol. 2022;29:3694\u2013708.","journal-title":"Ann Surg Oncol."},{"key":"18475_CR17","doi-asserted-by":"publisher","first-page":"e378","DOI":"10.1016\/S1470-2045(19)30332-8","volume":"20","author":"RN Amaria","year":"2019","unstructured":"Amaria RN, Menzies AM, Burton EM, et al. Neoadjuvant systemic therapy in melanoma: recommendations of the International Neoadjuvant Melanoma Consortium. Lancet Oncol. 2019;20:e378\u201389.","journal-title":"Lancet Oncol."},{"key":"18475_CR18","doi-asserted-by":"publisher","first-page":"948","DOI":"10.1016\/S1470-2045(19)30151-2","volume":"20","author":"EA Rozeman","year":"2019","unstructured":"Rozeman EA, Menzies AM, van Akkooi ACJ, et al. Identification of the optimal combination dosing schedule of neoadjuvant ipilimumab plus nivolumab in macroscopic stage III melanoma (OpACIN-neo): a multicentre, phase 2, randomised, controlled trial. Lancet Oncol. 2019;20:948\u201360.","journal-title":"Lancet Oncol."},{"key":"18475_CR19","doi-asserted-by":"publisher","first-page":"5300","DOI":"10.1245\/s10434-025-17330-9","volume":"32","author":"MM Dugan","year":"2025","unstructured":"Dugan MM, Beekman KE, DePalo DK, et al. The use of radar-guided localization to identify metastatic melanoma after neoadjuvant immunotherapy. Ann Surg Oncol. 2025;32:5300\u20135.","journal-title":"Ann Surg Oncol."}],"container-title":["Annals of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1245\/s10434-025-18475-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1245\/s10434-025-18475-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1245\/s10434-025-18475-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T12:40:18Z","timestamp":1770900018000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1245\/s10434-025-18475-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,14]]},"references-count":19,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["18475"],"URL":"https:\/\/doi.org\/10.1245\/s10434-025-18475-3","relation":{},"ISSN":["1068-9265","1534-4681"],"issn-type":[{"value":"1068-9265","type":"print"},{"value":"1534-4681","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,14]]},"assertion":[{"value":"12 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"ACJA discloses honoraria\/consultancy or advisory role with Amgen, Bristol-Myers Squibb, Daiichi Sankyo, Genmab, Menarini Silicon Biosystems, Merck Serono-Pfizer, MSD Merck, Neracare, Novartis, Pierre Fabre, Provectus, Replimune, Sanofi, Sirius Medical, SkylineDx, and 4SC. He discloses research funding from Amgen, Merck Serono\u2013Pfizer, SkylineDx. Georgina V. Long is consultant advisor for Agenus, Amgen, Array Biopharma, AstraZeneca, Bayer, BioNTech, Boehringer Ingelheim, Bristol Myers Squibb, Evaxion, Fortiva Biologics, GI Innovation, Hexal\u00a0AG (Sandoz Company), Highlight Therapeutics S.L., Immunocore, Innovent\u00a0Biologics USA, IOBiotech, Iovance Biotherapeutics, MSD, Novartis, PHMR\u00a0Ltd, Pierre Fabre, Regeneron, Scancell, and SkylineDX\u00a0B.V. RNA receives research funding from Obsidian, KSQ, Roche, Erasca, Onkure, and Regeneron. DEG has received honoraria\/consultancy from BMS, MSD, and Skyline Dx. JSZ has received honoriaria\/consulting fees from Delcath Systems, Merit Medical, Replimune, SkylineDX, Castle Biosciences, Philogen. He has received honoraria from Regeneron, Merck, and Menarini Silicon Biosystems as well as research funding from Delcath, Philogen, Provectus, SWOG, and NIH MTT has performed central pathology review for Merck and planned pathology review for Philogen. He has an advisory board role for Merck and Philogen and has lectured for Clinical Education Alliance. AMM has served on advisory boards for BMS, MSD, Novartis, Pierre-Fabre, Roche, and QBiotics. Piotr Rutkowski has received honoraria for lectures and advisory boards from MSD, BMS, Pierre Fabre, Novartis, Genesis Pharma, and Medison Pharma. MBF has received honoraria for advisory boards from Merck, BMS, and Replimune. PAA has\/had a consultant\/advisory role for Bristol Myers Squibb, Roche-Genentech, Merck Sharp & Dohme, Novartis, Pierre-Fabre, Sun Pharma, Immunocore, Italfarmaco, Boehringer-Ingelheim, Regeneron, Pfizer, Nouscom, Medicenna, Bio-Al Health, ValoTX, Replimmune, Bayer, Erasca, Philogen, Biontech, Anaveon, Genmab, Menarini, Incyte, and ImCheck therapeutics. He also received research funding from Bristol Myers Squibb, Roche-Genentech, Pfizer, and Regeneron. JMVM has served on advisory boards for Castle Biosciences and United Healthcare and is stock owner of Iovance Biotherapeutics and Doximity. The remaining authors have no conflicts of interest.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}}]}}