Prognostic outcomes of immediate complete lymph node dissection versus observation in patients with acral melanoma of the sole with sentinel node metastasis: a retrospective, multicenter study

Sadao Inoue; Shigeru Koizumi; Naoya Yamazaki; Yuki Ichigozaki; Hiroshi Kitagawa; Yukiko Kiniwa; Sayuri Sato; Toshihiro Takai; Reiichi Doi; Takamichi Ito; Masahito Yasuda; Yutaka Kuwatsuka; Takeo Maekawa; Jun Asai; Takuya Miyagawa; Shigeto Matsushita; Takeru Funakoshi; Yosuke Yamamoto; Takashi Inozume; Akiko Kishi; Tatsuya Takenouchi; Hiraku Kokubu; Shusaku Ito; Yoshiyasu Umeda; Yuki Yamamoto; Shoichiro Ishizuki; Shiro Iino; Hiroshi Uchi; Tomoe Nakagawa; Kazuhiro Inafuku; Takahiro Haga; Takahide Kaneko; Masahiro Nakagawa; Hideki Kamiya; Masaru Arima; Toshihiko Hoashi; Azusa Hiura; Nobuo Kanazawa; Keiko Manabe; Masashi Ishikawa; Kenji Asagoe; Utsugi Iwasawa; Takafumi Kadono; Naohito Hatta; Shoichiro Minami; Eiji Nakano; Dai Ogata; Satoshi Fukushima; Hisashi Uhara; Kenta Nakama; Takaya Komori; Ken Igawa; Yasuhiro Nakamura

doi:10.1007/s10147-025-02936-6

Prognostic outcomes of immediate complete lymph node dissection versus observation in patients with acral melanoma of the sole with sentinel node metastasis: a retrospective, multicenter study

Sadao Inoue
, Shigeru Koizumi
, Naoya Yamazaki
, Yuki Ichigozaki
, Hiroshi Kitagawa
, Yukiko Kiniwa
, Sayuri Sato
, Toshihiro Takai
, Reiichi Doi
, Takamichi Ito
, Masahito Yasuda
, Yutaka Kuwatsuka
, Takeo Maekawa
, Jun Asai
, Takuya Miyagawa
, Shigeto Matsushita
, Takeru Funakoshi
, Yosuke Yamamoto
, Takashi Inozume
, Akiko Kishi

Tatsuya Takenouchi, Hiraku Kokubu, Shusaku Ito, Yoshiyasu Umeda, Yuki Yamamoto, Shoichiro Ishizuki, Shiro Iino, Hiroshi Uchi, Tomoe Nakagawa, Kazuhiro Inafuku, Takahiro Haga, Takahide Kaneko, Masahiro Nakagawa, Hideki Kamiya, Masaru Arima, Toshihiko Hoashi, Azusa Hiura, Nobuo Kanazawa, Keiko Manabe, Masashi Ishikawa, Kenji Asagoe, Utsugi Iwasawa, Takafumi Kadono, Naohito Hatta, Shoichiro Minami, Eiji Nakano, Dai Ogata, Satoshi Fukushima, Hisashi Uhara, Kenta Nakama, Takaya Komori, Ken Igawa, Yasuhiro Nakamura

Dermatology

Research output: Contribution to journal › Article › peer-review

Abstract

Background: The clinical utility of immediate complete lymph node dissection (CLND) following positive sentinel node (SN) remains controversial in acral melanoma (AM), in Asian populations where AM is more prevalent. This study aimed to compare the survival outcomes of immediate CLND versus observation (OBS) in Japanese patients with stage III sole AM and positive SN. Methods: This retrospective, multicenter study included 154 patients (CLND: 90, OBS: 64) with stage III sole AM with positive SN, across 44 Japanese institutions. Recurrence-free survival (RFS), distant metastasis-free survival (DMFS), regional metastasis-free survival (RMFS), and overall survival (OS) were compared between the two groups. Cox multivariable analysis and propensity score matching (PSM) were performed to adjust for potential confounders. Results: With a median follow-up of 3.9 years, non-significant differences were observed in RFS, DMFS, RMFS, or OS between the CLND and OBS groups (P = 0.33, 0.32, 0.08, and 0.21, respectively). Cox multivariable analysis identified N3a nodal stage as an independent negative factor for OS (HR: 2.6, P = 0.02), whereas CLND and other variables were not associated. After PSM, 92 (46 each) were matched. RFS and DMFS remained comparable (P = 0.16 and 0.19), with a non-significant trend toward improved RMFS in the CLND group (P = 0.08), and no difference in OS (P = 0.14). Conclusions: Immediate CLND did not provide a survival advantage over OBS in patients with stage III sole AM and positive SN. These findings do not support the routine use of CLND in this population. Trial registration Not applicable.

Original language	English
Pages (from-to)	214-222
Number of pages	9
Journal	International Journal of Clinical Oncology
Volume	31
Issue number	1
DOIs	https://doi.org/10.1007/s10147-025-02936-6
Publication status	Published - 01-2026

All Science Journal Classification (ASJC) codes

Surgery
Hematology
Oncology

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10.1007/s10147-025-02936-6

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Inoue, S., Koizumi, S., Yamazaki, N., Ichigozaki, Y., Kitagawa, H., Kiniwa, Y., Sato, S., Takai, T., Doi, R., Ito, T., Yasuda, M., Kuwatsuka, Y., Maekawa, T., Asai, J., Miyagawa, T., Matsushita, S., Funakoshi, T., Yamamoto, Y., Inozume, T., ... Nakamura, Y. (2026). Prognostic outcomes of immediate complete lymph node dissection versus observation in patients with acral melanoma of the sole with sentinel node metastasis: a retrospective, multicenter study. International Journal of Clinical Oncology, 31(1), 214-222. https://doi.org/10.1007/s10147-025-02936-6

@article{649d5206fa504a5ca9283afdcdc70c0d,

title = "Prognostic outcomes of immediate complete lymph node dissection versus observation in patients with acral melanoma of the sole with sentinel node metastasis: a retrospective, multicenter study",

abstract = "Background: The clinical utility of immediate complete lymph node dissection (CLND) following positive sentinel node (SN) remains controversial in acral melanoma (AM), in Asian populations where AM is more prevalent. This study aimed to compare the survival outcomes of immediate CLND versus observation (OBS) in Japanese patients with stage III sole AM and positive SN. Methods: This retrospective, multicenter study included 154 patients (CLND: 90, OBS: 64) with stage III sole AM with positive SN, across 44 Japanese institutions. Recurrence-free survival (RFS), distant metastasis-free survival (DMFS), regional metastasis-free survival (RMFS), and overall survival (OS) were compared between the two groups. Cox multivariable analysis and propensity score matching (PSM) were performed to adjust for potential confounders. Results: With a median follow-up of 3.9 years, non-significant differences were observed in RFS, DMFS, RMFS, or OS between the CLND and OBS groups (P = 0.33, 0.32, 0.08, and 0.21, respectively). Cox multivariable analysis identified N3a nodal stage as an independent negative factor for OS (HR: 2.6, P = 0.02), whereas CLND and other variables were not associated. After PSM, 92 (46 each) were matched. RFS and DMFS remained comparable (P = 0.16 and 0.19), with a non-significant trend toward improved RMFS in the CLND group (P = 0.08), and no difference in OS (P = 0.14). Conclusions: Immediate CLND did not provide a survival advantage over OBS in patients with stage III sole AM and positive SN. These findings do not support the routine use of CLND in this population. Trial registration Not applicable.",

keywords = "Acral melanoma, Adjuvant therapy, Immediate complete lymph node dissection, Micrometastasis, Observation, Sentinel lymph node biopsy",

author = "Sadao Inoue and Shigeru Koizumi and Naoya Yamazaki and Yuki Ichigozaki and Hiroshi Kitagawa and Yukiko Kiniwa and Sayuri Sato and Toshihiro Takai and Reiichi Doi and Takamichi Ito and Masahito Yasuda and Yutaka Kuwatsuka and Takeo Maekawa and Jun Asai and Takuya Miyagawa and Shigeto Matsushita and Takeru Funakoshi and Yosuke Yamamoto and Takashi Inozume and Akiko Kishi and Tatsuya Takenouchi and Hiraku Kokubu and Shusaku Ito and Yoshiyasu Umeda and Yuki Yamamoto and Shoichiro Ishizuki and Shiro Iino and Hiroshi Uchi and Tomoe Nakagawa and Kazuhiro Inafuku and Takahiro Haga and Takahide Kaneko and Masahiro Nakagawa and Hideki Kamiya and Masaru Arima and Toshihiko Hoashi and Azusa Hiura and Nobuo Kanazawa and Keiko Manabe and Masashi Ishikawa and Kenji Asagoe and Utsugi Iwasawa and Takafumi Kadono and Naohito Hatta and Shoichiro Minami and Eiji Nakano and Dai Ogata and Satoshi Fukushima and Hisashi Uhara and Kenta Nakama and Takaya Komori and Ken Igawa and Yasuhiro Nakamura",

note = "Publisher Copyright: {\textcopyright} The Author(s) under exclusive licence to Japan Society of Clinical Oncology 2025.",

year = "2026",

month = jan,

doi = "10.1007/s10147-025-02936-6",

language = "English",

volume = "31",

pages = "214--222",

journal = "International Journal of Clinical Oncology",

issn = "1341-9625",

publisher = "Springer",

number = "1",

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Inoue, S, Koizumi, S, Yamazaki, N, Ichigozaki, Y, Kitagawa, H, Kiniwa, Y, Sato, S, Takai, T, Doi, R, Ito, T, Yasuda, M, Kuwatsuka, Y, Maekawa, T, Asai, J, Miyagawa, T, Matsushita, S, Funakoshi, T, Yamamoto, Y, Inozume, T, Kishi, A, Takenouchi, T, Kokubu, H, Ito, S, Umeda, Y, Yamamoto, Y, Ishizuki, S, Iino, S, Uchi, H, Nakagawa, T, Inafuku, K, Haga, T, Kaneko, T, Nakagawa, M, Kamiya, H, Arima, M, Hoashi, T, Hiura, A, Kanazawa, N, Manabe, K, Ishikawa, M, Asagoe, K, Iwasawa, U, Kadono, T, Hatta, N, Minami, S, Nakano, E, Ogata, D, Fukushima, S, Uhara, H, Nakama, K, Komori, T, Igawa, K & Nakamura, Y 2026, 'Prognostic outcomes of immediate complete lymph node dissection versus observation in patients with acral melanoma of the sole with sentinel node metastasis: a retrospective, multicenter study', International Journal of Clinical Oncology, vol. 31, no. 1, pp. 214-222. https://doi.org/10.1007/s10147-025-02936-6

Prognostic outcomes of immediate complete lymph node dissection versus observation in patients with acral melanoma of the sole with sentinel node metastasis: a retrospective, multicenter study. / Inoue, Sadao; Koizumi, Shigeru; Yamazaki, Naoya et al.
In: International Journal of Clinical Oncology, Vol. 31, No. 1, 01.2026, p. 214-222.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Prognostic outcomes of immediate complete lymph node dissection versus observation in patients with acral melanoma of the sole with sentinel node metastasis

T2 - a retrospective, multicenter study

AU - Inoue, Sadao

AU - Koizumi, Shigeru

AU - Yamazaki, Naoya

AU - Ichigozaki, Yuki

AU - Kitagawa, Hiroshi

AU - Kiniwa, Yukiko

AU - Sato, Sayuri

AU - Takai, Toshihiro

AU - Doi, Reiichi

AU - Ito, Takamichi

AU - Yasuda, Masahito

AU - Kuwatsuka, Yutaka

AU - Maekawa, Takeo

AU - Asai, Jun

AU - Miyagawa, Takuya

AU - Matsushita, Shigeto

AU - Funakoshi, Takeru

AU - Yamamoto, Yosuke

AU - Inozume, Takashi

AU - Kishi, Akiko

AU - Takenouchi, Tatsuya

AU - Kokubu, Hiraku

AU - Ito, Shusaku

AU - Umeda, Yoshiyasu

AU - Yamamoto, Yuki

AU - Ishizuki, Shoichiro

AU - Iino, Shiro

AU - Uchi, Hiroshi

AU - Nakagawa, Tomoe

AU - Inafuku, Kazuhiro

AU - Haga, Takahiro

AU - Kaneko, Takahide

AU - Nakagawa, Masahiro

AU - Kamiya, Hideki

AU - Arima, Masaru

AU - Hoashi, Toshihiko

AU - Hiura, Azusa

AU - Kanazawa, Nobuo

AU - Manabe, Keiko

AU - Ishikawa, Masashi

AU - Asagoe, Kenji

AU - Iwasawa, Utsugi

AU - Kadono, Takafumi

AU - Hatta, Naohito

AU - Minami, Shoichiro

AU - Nakano, Eiji

AU - Ogata, Dai

AU - Fukushima, Satoshi

AU - Uhara, Hisashi

AU - Nakama, Kenta

AU - Komori, Takaya

AU - Igawa, Ken

AU - Nakamura, Yasuhiro

PY - 2026/1

Y1 - 2026/1

N2 - Background: The clinical utility of immediate complete lymph node dissection (CLND) following positive sentinel node (SN) remains controversial in acral melanoma (AM), in Asian populations where AM is more prevalent. This study aimed to compare the survival outcomes of immediate CLND versus observation (OBS) in Japanese patients with stage III sole AM and positive SN. Methods: This retrospective, multicenter study included 154 patients (CLND: 90, OBS: 64) with stage III sole AM with positive SN, across 44 Japanese institutions. Recurrence-free survival (RFS), distant metastasis-free survival (DMFS), regional metastasis-free survival (RMFS), and overall survival (OS) were compared between the two groups. Cox multivariable analysis and propensity score matching (PSM) were performed to adjust for potential confounders. Results: With a median follow-up of 3.9 years, non-significant differences were observed in RFS, DMFS, RMFS, or OS between the CLND and OBS groups (P = 0.33, 0.32, 0.08, and 0.21, respectively). Cox multivariable analysis identified N3a nodal stage as an independent negative factor for OS (HR: 2.6, P = 0.02), whereas CLND and other variables were not associated. After PSM, 92 (46 each) were matched. RFS and DMFS remained comparable (P = 0.16 and 0.19), with a non-significant trend toward improved RMFS in the CLND group (P = 0.08), and no difference in OS (P = 0.14). Conclusions: Immediate CLND did not provide a survival advantage over OBS in patients with stage III sole AM and positive SN. These findings do not support the routine use of CLND in this population. Trial registration Not applicable.

AB - Background: The clinical utility of immediate complete lymph node dissection (CLND) following positive sentinel node (SN) remains controversial in acral melanoma (AM), in Asian populations where AM is more prevalent. This study aimed to compare the survival outcomes of immediate CLND versus observation (OBS) in Japanese patients with stage III sole AM and positive SN. Methods: This retrospective, multicenter study included 154 patients (CLND: 90, OBS: 64) with stage III sole AM with positive SN, across 44 Japanese institutions. Recurrence-free survival (RFS), distant metastasis-free survival (DMFS), regional metastasis-free survival (RMFS), and overall survival (OS) were compared between the two groups. Cox multivariable analysis and propensity score matching (PSM) were performed to adjust for potential confounders. Results: With a median follow-up of 3.9 years, non-significant differences were observed in RFS, DMFS, RMFS, or OS between the CLND and OBS groups (P = 0.33, 0.32, 0.08, and 0.21, respectively). Cox multivariable analysis identified N3a nodal stage as an independent negative factor for OS (HR: 2.6, P = 0.02), whereas CLND and other variables were not associated. After PSM, 92 (46 each) were matched. RFS and DMFS remained comparable (P = 0.16 and 0.19), with a non-significant trend toward improved RMFS in the CLND group (P = 0.08), and no difference in OS (P = 0.14). Conclusions: Immediate CLND did not provide a survival advantage over OBS in patients with stage III sole AM and positive SN. These findings do not support the routine use of CLND in this population. Trial registration Not applicable.

KW - Acral melanoma

KW - Adjuvant therapy

KW - Immediate complete lymph node dissection

KW - Micrometastasis

KW - Observation

KW - Sentinel lymph node biopsy

UR - https://www.scopus.com/pages/publications/105024005454

UR - https://www.scopus.com/pages/publications/105024005454#tab=citedBy

U2 - 10.1007/s10147-025-02936-6

DO - 10.1007/s10147-025-02936-6

M3 - Article

C2 - 41345808

AN - SCOPUS:105024005454

SN - 1341-9625

VL - 31

SP - 214

EP - 222

JO - International Journal of Clinical Oncology

JF - International Journal of Clinical Oncology

IS - 1

ER -

Prognostic outcomes of immediate complete lymph node dissection versus observation in patients with acral melanoma of the sole with sentinel node metastasis: a retrospective, multicenter study

Abstract

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