Does elective lymph node dissection (ELND) improve cure rates in patients with melanoma?

The Mayo Clinic trial and World Health Organization melanoma group trial have not shown a benefit for ELND for stage I and II melanoma involving the extremities and trunk. The Intergroup Melanoma Trial demonstrated that for patients younger than 60 years with tumors 1.1-2.0 mm thick, there was a significant improvement in 5-year survival (96% versus 84%). However, beginning with the work of Morton et al., who used lymphoscintigraphy to identify routes of lymph drainage and SLN identification, SLN biopsy has come to the fore. In this approach, the first-echelon node is removed. If it is negative for metastasis, further node dissection is not performed. (If the SLN is positive for metastasis, surgical lymph node dissection is completed at a separate time.)