Four RCTs have compared elective lymph node dissection with primary excision of the cutaneous lesion only. In all, 1718 people with no clinical evidence of lymph node metastases have been entered into the studies. None of these studies showed an overall survival benefit in patients receiving elective lymph node dissection. However, an unplanned subset analysis found non-significant trends in favour of elective lymph node dissection in those over the age of 60 years with intermediate thickness tumours.35-38

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