Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma.

Sentinel-lymph-node biopsy is associated with increased melanoma-specific survival (i.e., survival until death from melanoma) among patients with node-positive intermediate-thickness melanomas (1.2 to 3.5 mm). The value of completion lymph-node dissection for patients with sentinel-node metastases is not clear. In an international trial, we randomly assigned patients with sentinel-node metastases detected by means of standard pathological assessment or a multimarker molecular assay to immediate completion lymph-node dissection (dissection group) or nodal observation with ultrasonography (observation group). The primary end point was melanoma-specific survival. Secondary end points included disease-free survival and the cumulative rate of nonsentinel-node metastasis. Immediate completion lymph-node dissection was not associated with increased melanoma-specific survival among 1934 patients with data that could be evaluated in an intention-to-treat analysis or among 1755 patients in the per-protocol analysis. In the per-protocol analysis, the mean (±SE) 3-year rate of melanoma-specific survival was similar in the dissection group and the observation group (86±1.3% and 86±1.2%, respectively; P=0.42 by the log-rank test) at a median follow-up of 43 months. The rate of disease-free survival was slightly higher in the dissection group than in the observation group (68±1.7% and 63±1.7%, respectively; P=0.05 by the log-rank test) at 3 years, based on an increased rate of disease control in the regional nodes at 3 years (92±1.0% vs. 77±1.5%; P<0.001 by the log-rank test); these results must be interpreted with caution. Nonsentinel-node metastases, identified in 11.5% of the patients in the dissection group, were a strong, independent prognostic factor for recurrence (hazard ratio, 1.78; P=0.005). Lymphedema was observed in 24.1% of the patients in the dissection group and in 6.3% of those in the observation group. Immediate completion lymph-node dissection increased the rate of regional disease control and provided prognostic information but did not increase melanoma-specific survival among patients with melanoma and sentinel-node metastases. (Funded by the National Cancer Institute and others; MSLT-II ClinicalTrials.gov number, NCT00297895 .)

Rubidium-strontium age studies and geochemistry of acid veins in the Freetown complex, Sierra Leone

The stratigraphical limits on the age of the Freetown intrusion, Sierra Leone, are very wide, yet the intrusion has not previously been accurately dated by isotopic methods, despite a number of attempts. Rubidium-strontium dating of acid veins contemporaneous with the early stages of the prolonged cooling history of the intrusion provides an age of 193 ± 3 Ma. The veins consist of quartz and orthoclase with relict minerals, principally plagioclase, from thehost gabbro. Electron-microprobe analysis of the altered minerals of the veins, and the petrography of the vein and adjacent host gabbro clearly demonstrate that the veins were formed from a granitic fraction, differentiated in situ from the surrounding solid gabbro with the assistance of a hydrous fluid phase within the incipient vein. This assertion is supported by the identical, low value of the initial 87Sr/86Sr ratio (0·70389) obtained from both the acid and basic rocks, and the technique described here may be useful in dating other, similar, intrusions