[6] In the MSLT - 1 trial, patients with isolated nodal recurrence had more total lymph nodes involved by melanoma than patients randomized to SLN biopsy who had a positive biopsy (all of whom were to have CLND; an average of 3.2 lymph nodes involved with metastatic melanoma vs only 1.4 positive nodes, respectively; P <.0001), [2] and were more
likely to meet established criteria for adjuvant radiation, [7] which further increases the risk of postoperative
lymphedema.