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Aim Cutaneous malignant melanoma is a significant public health challenge in the United Kingdom. Since the new American Joint Committee on Cancer (AJCC) version 8 definition of melanoma staging, more melanoma patients are eligible for sentinel lymph node biopsies (SLNB). Prior to the MSLT-II trial, SLNB positive patients were treated as a distinct group within cutaneous melanoma patients and in most centres would routinely undergo lymph node clearance (LNC) of the regional lymph node basin to control disease. Given the above developments in melanoma care, we compared the cost of SLNB and monitoring to the cost of LNC for patients with melanoma. Method We retrospectively reviewed all SLNB positive patients undergoing LNC or surveillance in 2019. We measured the cost of all clinical encounters for both groups and performed a cost analysis. Results Our study shows that the mean cost per patient of axillary LNC is £4731.64 and groin LNC is £5381.78 against a cost of £2896.67 for SLNBs. Mean inpatient stay was 2.8 nights following LNC and 0.11 nights following SLNB. 50% of LNCs and 11% of SLNBs were associated with post-operative complications. Conclusions Our data shows that treating uncomplicated SLNB positive patients with surveillance rather than immediate LNC results in reduced morbidity, lower complication rate and shorter inpatient stay for the patients, as well as lower financial burden to the unit. This is reflected by the UK Consensus statement on melanoma, suggesting that LNC should not be routinely offered for positive SLNB without high-risk features.

british journal of surgery

1099 Financial Implications of Implementing MSLT-II Trial Findings for Treatment of Cutaneous Malignant Melanoma Patients in A Tertiary Referral Centre in The United Kingdom