Abstract
BACKGROUND: Completion lymph node dissection (CLND) is recommended for melanoma patients with positive sentinel lymph node biopsies (SLNB); however, 50% do not undergo CLND. We sought to determine CLND trends over time, and factors contributing to variability. METHODS: The NCDB was queried for patients undergoing wide local excision (WLE), with or without SLNB and CLND. Cohorts were created based on demographic/socioeconomic variables and era of treatment (Era 1: 2003-07, Era 2: 2008-12). Univariate and multivariate analyses identified factors associated with performance of or trends in CLND. RESULTS: 122 849 underwent WLE with SLNB. Of 24 267 (19.8%) with +SLNB, 13 594 (56.0%) continued to CLND. In multivariate analyses, Medicaid (OR 0.78; P = 0.04) or Medicare (OR 0.79; P < 0.01) in Era 1 and patients without insurance in Era 2 (OR 0.78; P = 0.01) underwent less CLND. In both eras, Blacks (OR 0.45; P < 0.01, OR 0.59; P < 0.01), head/neck lesions (OR 0.72; P < 0.01, OR 0.66; P < 0.01) and lower extremity lesions (OR 0.75; P < 0.01, OR 0.72; P < 0.01) underwent less CLND. However, Blacks experienced greatest increase in CLND usage (+9.2%). CONCLUSIONS: CLND usage continues to be low and racial/socioeconomic disparities persist. Until the results of MSLT-2 become available, continued focus on understanding poor adherence to, and improving rates of CLND is necessary.