ArticleAnnals of surgical oncology2026
Is Ultrasound-Based Imaging Essential for Melanoma Active Surveillance?
Article in Annals of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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13 authors.
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Abstract
backgroundTwo landmark trials demonstrated that active surveillance with nodal ultrasound (US) yields equivalent oncologic outcomes to completion lymph node dissection (CLND) in sentinel lymph node (SLN)-positive melanoma. Yet, real-world adherence to US surveillance remains inconsistent, and its role alongside modern cross-sectional imaging is inadequately defined.
methodsIn a retrospective cohort of SLN-positive adults diagnosed from 2017 to 2023 at an NCI-designated integrated health network, adherence to guideline-concordant surveillance was assessed for 2 years following definitive resection. We evaluated recurrence detection patterns and the diagnostic yield of biopsies prompted by each surveillance modality. Multivariable logistic regression identified predictors of surveillance adherence.
resultsAmong 240 patients, 223 (92.9%) were planned for active surveillance, while 17 (7.1%) underwent immediate CLND. Of surveillance patients, 55.3% and 88.0% underwent guideline-concordant US and cross-sectional imaging, respectively. Later diagnosis (2021-2023) predicted US adherence, while older age and head and neck tumors predicted lower use. During a median follow-up of 36.4 months, 77 patients (32.1%) developed recurrence, most commonly distant (n=29) or in the draining nodal basin (n=26), with fewer local (n=11) and in transit (n=11) recurrences. Cross-sectional imaging detected 50 recurrences (64.9%), including 27 distant and 17 nodal recurrences. US detected 6 (7.8%) and prompted more negative biopsies (n=11) than true positives (n=6).
conclusionsCross-sectional imaging was more consistently performed and diagnostically effective than nodal basin US. These findings highlight an opportunity to modernize surveillance programs, minimize excessive testing, and reexamine the strict application of MSLT-II trial protocols in contemporary practice.
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