---
title: "Omitting Sentinel Lymph Node Biopsy in Melanoma with Neoadjuvant Immunotherapy"
id: "pubmed-42748588"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42748588"
content_type: "clinical_feed_article"
specialty: "Oncology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42748588/"
doi: "10.1016/j.ejca.2026.117038"
published_at: "2026-10-16T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Omitting Sentinel Lymph Node Biopsy in Melanoma with Neoadjuvant Immunotherapy
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42748588
- **Specialty:** [Oncology](https://medichelpline.com/clinical-feed/oncology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42748588/)
- **DOI:** [10.1016/j.ejca.2026.117038](https://doi.org/10.1016%2Fj.ejca.2026.117038)
- **Published At:** 2026-10-16T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The authors used data from pivotal melanoma immunotherapy trials and the MSLT-1 trial to model clinical outcomes. - They compared two strategies: performing **sentinel lymph node biopsy** (SLNB) with adjuvant immunotherapy for node-positive patients versus omitting SLNB and observing clinically, treating nodal recurrence with **neoadjuvant immunotherapy**. - A Markov model simulated distant metastasis-free survival (DMFS) for the two pathways. - Investigators modeled a scenario where nodal recurrence, if it occurred after omission of SLNB, was treated with neoadjuvant anti-PD-1 plus anti-CTLA-4 therapy prior to nodal surgery. - Data indicated omission of SLNB with later neoadjuvant combination therapy produced an absolute DMFS improvement of 8–19 percentage points compared with the SLNB-then-adjuvant approach. - The magnitude of benefit depended on Breslow thickness; thicker primaries altered modeled outcomes. - Authors noted that omitting SLNB could reduce surgical morbidity, lower the number of immunotherapy doses required, and potentially improve long-term oncological outcomes. - The source did not report specific patient selection criteria, exact model parameters, or detailed dosing regimens from the trials used in the simulation. - The study authors argued these results support conducting an international randomized controlled trial to re-evaluate the role of SLNB in the current neoadjuvant era. - The paper reports no declared competing financial interests.
## Clinical Analysis & Structured Key Points
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Epub 2026 Sep 10. # Sentinel lymph node biopsy in melanoma: Redundant in the neoadjuvant era [Antonius W Schurink](https://pubmed.ncbi.nlm.nih.gov/?term=Schurink+AW&cauthor_id=42748588)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42748588/#full-view-affiliation-1 "Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands."), [Josephine C Janssen](https://pubmed.ncbi.nlm.nih.gov/?term=Janssen+JC&cauthor_id=42748588)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42748588/#full-view-affiliation-2 "Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands."), [Peter L van Hulst](https://pubmed.ncbi.nlm.nih.gov/?term=van+Hulst+PL&cauthor_id=42748588)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42748588/#full-view-affiliation-3 "Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands."), [Hester F Lingsma](https://pubmed.ncbi.nlm.nih.gov/?term=Lingsma+HF&cauthor_id=42748588)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42748588/#full-view-affiliation-4 "Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands."), [Cornelis Verhoef](https://pubmed.ncbi.nlm.nih.gov/?term=Verhoef+C&cauthor_id=42748588)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42748588/#full-view-affiliation-1 "Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands."), [Dirk J Grünhagen](https://pubmed.ncbi.nlm.nih.gov/?term=Gr%C3%BCnhagen+DJ&cauthor_id=42748588)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42748588/#full-view-affiliation-5 "Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands. Electronic address: d.grunhagen@erasmusmc.nl.") Affiliations Expand ### Affiliations * 1 Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands. * 2 Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands. * 3 Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands. * 4 Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands. * 5 Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands. Electronic address: d.grunhagen@erasmusmc.nl. * PMID: **42748588** * DOI: [ 10.1016/j.ejca.2026.117038 ](https://doi.org/10.1016/j.ejca.2026.117038) Free article Item in Clipboard # Sentinel lymph node biopsy in melanoma: Redundant in the neoadjuvant era Antonius W Schurink et al. Eur J Cancer. 2026. Free article Show details Display options Display options Format Abstract PubMed PMID Eur J Cancer Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Eur+J+Cancer%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Eur+J+Cancer%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42748588/) . 2026 Oct 16:247:117038. doi: 10.1016/j.ejca.2026.117038. Epub 2026 Sep 10. ### Authors [Antonius W Schurink](https://pubmed.ncbi.nlm.nih.gov/?term=Schurink+AW&cauthor_id=42748588)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42748588/#short-view-affiliation-1 "Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands."), [Josephine C Janssen](https://pubmed.ncbi.nlm.nih.gov/?term=Janssen+JC&cauthor_id=42748588)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42748588/#short-view-affiliation-2 "Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands."), [Peter L van Hulst](https://pubmed.ncbi.nlm.nih.gov/?term=van+Hulst+PL&cauthor_id=42748588)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42748588/#short-view-affiliation-3 "Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands."), [Hester F Lingsma](https://pubmed.ncbi.nlm.nih.gov/?term=Lingsma+HF&cauthor_id=42748588)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42748588/#short-view-affiliation-4 "Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands."), [Cornelis Verhoef](https://pubmed.ncbi.nlm.nih.gov/?term=Verhoef+C&cauthor_id=42748588)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42748588/#short-view-affiliation-1 "Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands."), [Dirk J Grünhagen](https://pubmed.ncbi.nlm.nih.gov/?term=Gr%C3%BCnhagen+DJ&cauthor_id=42748588)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42748588/#short-view-affiliation-5 "Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands. Electronic address: d.grunhagen@erasmusmc.nl.") ### Affiliations * 1 Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands. * 2 Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands. * 3 Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands. * 4 Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands. * 5 Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands. Electronic address: d.grunhagen@erasmusmc.nl. * PMID: **42748588** * DOI: [ 10.1016/j.ejca.2026.117038 ](https://doi.org/10.1016/j.ejca.2026.117038) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Background:** Neoadjuvant immunotherapy has emerged as a superior strategy to adjuvant immunotherapy for patients with resectable, clinically detectable stage III melanoma, significantly improving event-free survival. In microscopic stage III disease, adjuvant immunotherapy is generally considered standard of care, although lack of survival benefit prompts re-evaluation of this sentinel lymph node biopsy (SLND) plus adjuvant therapy approach. Specifically, omission of SLNB may not only spare patients from surgery but also facilitate more effective systemic therapy, reduce the required number of immunotherapy doses, and potentially improve long-term oncological outcomes. **Methods:** Data from pivotal melanoma immunotherapy trials and MSLT-1 trail were used to model two clinical scenarios: (1) SLNB followed by adjuvant immunotherapy in patients with a positive sentinel lymph node, and (2) omission of SLNB and clinical observation. A subsequent nodal recurrence then treated using neoadjuvant anti-PD-1 plus anti-CTLA-4 immunotherapy. Distant metastasis-free survival (DMFS) was simulated using a Markov model. **Findings:** Omission of SLNB with treatment of nodal recurrence using neoadjuvant combination immunotherapy resulted in a 8-19 percentage point improvement in DMFS compared with the SLNB strategy followed by adjuvant immunotherapy in patients with a positive sentinel lymph node. The magnitude of benefit varied according to Breslow thickness. **Interpretation:** Omitting SLNB may improve oncological outcomes in patients with melanoma in the era of neoadjuvant immunotherapy. These findings provide a compelling rationale for an international randomized controlled trial to re-evaluate the role of SLNB within contemporary melanoma treatments. **Keywords:** Adjuvant immunotherapy; Melanoma; Neoadjuvant immunotherapy; Omitting SLNB; SLNB. Copyright © 2026 The Authors. Published by Elsevier Ltd.. All rights reserved. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. ## Similar articles * [ Adjuvant therapy of malignant melanoma and the role of sentinel node mapping. ](https://pubmed.ncbi.nlm.nih.gov/10857171/) Eggermont AM.Eggermont AM.Recent Results Cancer Res. 2000;157:178-89. doi: 10.1007/978-3-642-57151-0_15.Recent Results Cancer Res. 2000.PMID: 10857171Review. * [ Management of Localized Melanoma in the Anti-PD-1 Era. ](https://pubmed.ncbi.nlm.nih.gov/38842606/) Novis E, van Akkooi ACJ.Novis E, et al.Curr Oncol Rep. 2024 Aug;26(8):924-933. doi: 10.1007/s11912-024-01556-z. Epub 2024 Jun 6.Curr Oncol Rep. 2024.PMID: 38842606Free PMC article.Review. * [ Evaluation of Clinical Outcomes and Pattern of Recurrence in Patients with Cutaneous Melanoma and Sentinel Lymph Node Positivity Since the Publication of the MSLT-2 Trial. ](https://pubmed.ncbi.nlm.nih.gov/41746574/) Mor E, Apte S, Bressel M, Broman KK, Hieken TJ, Olofsson Bagge R, Berman RS, Lee AY, Kuijpers AM, Ollila DW, van Akkooi ACJ, Zager JS, Gyorki DE.Mor E, et al.Ann Surg Oncol. 2026 Jun;33(6):4991-5001. doi: 10.1245/s10434-026-19260-6. Epub 2026 Feb 26.Ann Surg Oncol. 2026.PMID: 41746574 * [ Sentinel lymph node status and oncological outcomes of high-risk and low-risk cutaneous primary melanoma. ](https://pubmed.ncbi.nlm.nih.gov/41826996/) Mohamed HS, Fadel MG, Wilkinson MJ, Hadjicosta O, Weir J, Power K, Hayes AJ, Smith MJ.Mohamed HS, et al.World J Surg Oncol. 2026 Mar 13;24(1):184. doi: 10.1186/s12957-026-04278-7.World J Surg Oncol. 2026.PMID: 41826996Free PMC article. * [ National Trends in Management of the Nodal Basin for Pediatric Patients With Occult Stage III Melanoma in the United States. ](https://pubmed.ncbi.nlm.nih.gov/40038909/) Beckhorn CB, Rhodin KE, Leraas HJ, Farrow NE, Lee JS, Beasley GM, Tracy ET.Beckhorn CB, et al.Pediatr Blood Cancer. 2025 May;72(5):e31627. doi: 10.1002/pbc.31627. Epub 2025 Mar 4.Pediatr Blood Cancer. 2025.PMID: 40038909 [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42748588) ## MeSH terms * Chemotherapy, Adjuvant Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Chemotherapy%2C+Adjuvant%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Chemotherapy%2C+Adjuvant) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42748588/) * Humans Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Humans%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Humans) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42748588/) * Immunotherapy / methods Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Immunotherapy%2Fmethods%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Immunotherapy) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42748588/) * Lymphatic Metastasis Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Lymphatic+Metastasis%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Lymphatic+Metastasis) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42748588/) * Melanoma* / drug therapy Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Melanoma%2Fdrug+therapy%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Melanoma) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42748588/) * Melanoma* / immunology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Melanoma%2Fimmunology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Melanoma) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42748588/) * Melanoma* / mortality Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Melanoma%2Fmortality%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Melanoma) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42748588/) * Melanoma* / pathology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Melanoma%2Fpathology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Melanoma) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42748588/) * Melanoma* / therapy Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Melanoma%2Ftherapy%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Melanoma) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42748588/) * Neoadjuvant Therapy* / methods Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Neoadjuvant+Therapy%2Fmethods%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Neoadjuvant+Therapy) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42748588/) * Sentinel Lymph Node / pathology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Sentinel+Lymph+Node%2Fpathology%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Sentinel+Lymph+Node) * [ Add to Search ](
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