Simple SummaryIn this study, the treatment trends and survival among 557 patients with sentinel lymph node biopsy (SLNB)-positive melanomas were analyzed. We have demonstrated the increasing role of the adjuvant systemic treatment and the non-proportional character in the RFS improvement during and after the adjuvant. The completion lymph node dissection (CLND) has, for years, been the standard of care for patients with clinically occult node-positive melanoma, although recently published multicenter randomized studies indicate a similar survival benefit for active surveillance in the groups where the multiple adjuvant systemic therapies have been implemented in patients after surgical resection of sentinel node metastases and in patients qualified for systemic adjuvant therapy without CLND. The limitation of our study was non-complete pathological reports outside reference oncological centers, especially in terms of the subtype of primary melanoma and the maximal size of the metastatic focus in the sentinel lymph node. Treatment of SLNB-positive melanoma patients is constantly evolving, and the role of surgery is currently rather limited. Whether CLND has been performed or not, in a group of SLNB-positive patients, adjuvant systemic treatment should be offered to all eligible patients.AbstractBackground: In melanoma treatment, an approach following positive sentinel lymph node biopsy (SLNB) has been recently deescalated from completion lymph node dissection (CLND) to active surveillance based on phase III trials data. In this study, we aim to evaluate treatment strategies in SLNB-positive melanoma patients in real-world practice. Methods: Five-hundred-fifty-seven melanoma SLNB-positive patients from seven comprehensive cancer centers treated between 2017 and 2021 were included. Kaplan–Meier methods and the Cox Proportional-Hazards Model were used for analysis. Results: The median follow-up was 25 months. Between 2017 and 2021, the percentage of patients undergoing CLND decreased (88–41%), while the use of adjuvant treatment increased (11–51%). The 3-year OS and RFS rates were 77.9% and 59.6%, respectively. Adjuvant therapy prolonged RFS (HR:0.69,p =0.036)), but CLND did not (HR:1.22,p =0.272). There were no statistically significant differences in OS for either adjuvant systemic treatment or CLND. Lower progression risk was also found, and time-dependent hazard ratios estimation in patients treated with systemic adjuvant therapy was confirmed (HR:0.20,p =0.002 for BRAF inhibitors and HR:0.50,p =0.015 for anti-PD-1 inhibitors). Conclusions: Treatment of SLNB-positive melanoma patients is constantly evolving, and the role of surgery is currently rather limited. Whether CLND has been performed or not, in a group of SLNB-positive patients, adjuvant systemic treatment should be offered to all eligible patients.