ArticleAnnals of surgical oncology2026
Missed Opportunities for Neoadjuvant Immunotherapy in Melanoma: Is it Time to Consider Ultrasound Staging for Newly Diagnosed Patients?
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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Abstract
backgroundMelanoma treatment for patients with clinical adenopathy has improved outcomes with neoadjuvant immunotherapy (NAI). Some sentinel lymph node (SLN)-positive patients have larger pathologic metastases that might be identified on ultrasound (US) preoperatively. We sought to identify SLN-eligible patients with larger nodal metastases and identify characteristics to estimate patients who might have nodal metastases identified by staging US. PATIENTS AND
methodsPatients with clinical stage IB/II melanoma who underwent a SLNB for which the pathological size of the metastases were retrospectively identified. Comparative statistics were performed for patients with macrometastases (≥ 10 mm) compared with micrometastases (< 10 mm), as well as for 0-4 mm and 4 to < 10 mm metastases.
resultsThere were 198 patients with clinical stage IB/II melanoma who underwent SLNB for which 41 (20.7%) had a positive node, and 39 (19.7%) had metastasis size recorded. There were 6/39 (15.4%) with a macro metastasis identified, of which 5 were clinical stage II. Median body mass index (BMI) was higher in the macro metastases group versus the micro metastases group (42.0 versus 28.9, p = 0.0307). There were 11/91 (12.1%) clinical stage II patients with metastases ≥ 4 mm.
conclusionsIn our patients with stage IB/II melanoma, 15.4% had a SLN metastasis ≥ 10 mm and were more likely to be obese, suggesting physical exam was less sensitive for these patients. With a 4 mm cutoff, staging US might upstage 12% of clinical stage II to pathologic stage III. We recommend consideration of staging US for all clinical stage II patients.
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