***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE A prospect i ve multi-institutional r and omized surgical trial involving 740 stage I and II melanoma patients was conducted by the Intergroup Melanoma Surgical Program to determine whether elective ( immediate ) lymph node dissection ( ELND ) for intermediate-thickness melanoma ( 1 - 4 mm ) improves survival rates compared with clinical observation of the lymph nodes . A second objective was to define subgroups of melanoma patients who would have a higher survival with ELND . METHODS The eligible patients were stratified according to tumor thickness , anatomic site , and ulceration , and then were prer and omized to either ELND or nodal observation . Femoral , axillary , or modified neck dissections were performed using st and ardized surgical guidelines . RESULTS The median follow-up was 7.4 years . A multifactorial ( Cox regression ) analysis showed that the following factors independently influenced survival : tumor ulceration , trunk site , tumor thickness , and patient age . Surgical treatment results were first compared based on r and omized intent . Overall 5-year survival was not significantly different for patients who received ELND or nodal observation . However , the 552 patients 60 years of age or younger ( 75 % of total group ) with ELND has a significantly better 5-year survival . Among these patients , 5-year survival was better with ELND versus nodal observation for the 335 patients with tumors 1 to 2 mm thick , the 403 patients without tumor ulceration , and the 284 patients with tumors 1 to 2 mm thick and no ulceration . In contrast , patients older than 60 years of age who had ELND actually had a lower survival trend than those who had nodal observation . When survival rates were compared based on treatment actually received ( i.e. , including crossover patients ) , the patients with significantly improved 5-year survival rates after ELND included those with tumors 1 to 2 mm thick , those without tumor ulceration , and those 60 years of age or younger with tumors 1 to 2 mm thick or without ulceration . CONCLUSION This is the first r and omized study to prove the value of surgical treatment for clinical ly occult regional metastases . Patients 60 years or age or younger with intermediate-thickness melanomas , especially with nonulcerative melanoma and those with tumors 1 to 2 mm thick , may benefit from ELND . However , because some patients still are developing distant disease , these results should be considered an interim analysis Results of a prospect i ve r and omized clinical trial conducted by the WHO Collaborating Centers for the Evaluation of Methods of Diagnosis and Treatment of Melanoma are reported . Five‐hundred‐fifty‐three Stage I patients whose limbs were affected entered the study ; 267 were su bmi tted to wide excision and immediate node dissection and 286 had wide excision and node dissection at the time clinical ly positive nodes were detected . Survival curves of the two treatment groups could be superimposed . No subsets of patients benefitted from immediate node dissection . The authors conclude that  delayed node dissection  is as effective as the immediate dissection in Stage I melanoma of the extremities if the patient can be checked every three months . If the quarterly follow‐up is not guaranteed , immediate node dissection is advisable , at least for melanomas thicker than 2 mm PURPOSE Interferon alfa-2b ( IFN alpha-2b ) exhibits antitumor activity in metastatic melanoma and on this basis has been evaluated as an adjuvant therapy following surgery for deep primary ( T4 ) or regionally metastatic ( N1 ) melanoma . METHODS A r and omized controlled study of IFN alpha-2b ( Schering-Plough , Kenilworth , NJ ) administered at maximum-tolerated doses of 20 MU/m2/d intravenously ( i.v . ) for 1 month and 10 MU/m2 three times per week subcutaneously ( SC ) for 48 weeks versus observation , was conducted by the Eastern Cooperative Oncology Group ( ECOG ) in 287 patients . RESULTS A significant prolongation of relapse-free survival ( P = .0023 , one-sided ) and prolongation of overall survival ( P = .0237 , one-sided ) was observed with IFN alpha-2b therapy in this trial , which is now mature with a median follow-up time of 6.9 years . The impact of treatment on relapse rate is most pronounced early during the treatment interval . The overall benefit of treatment in this trial was analyzed stratified by tumor burden and the presence or absence of microscopic nonpalpable and palpable regional lymph node metastasis . The benefit of therapy with IFN alpha-2b was greatest among node-positive strata . Toxicity of IFN alpha-2b required dose modification in the majority of patients , but treatment at > or = 80 % of the scheduled dose was feasible in the majority of patients through the IV phase of treatment , and for more than 3 months of SC maintenance therapy . Discontinuation of treatment due to toxicity was infrequent after the fourth month of therapy . CONCLUSION IFN alpha-2b prolongs the relapse-free interval and overall survival of high-risk resected melanoma patients . The increment in median disease-free survival ( from 1 to 1.7 years ) and overall survival ( from 2.8 to 3.8 years ) that results from this therapy is associated with a 42 % improvement in the fraction of patients who are continuously disease-free after treatment with IFN ( from 26 % to 37 % ) in comparison to observation . IFN alpha-2b is the first agent to show a significant benefit in relapse-free and overall survival of high-risk melanoma patients in a r and omized controlled trial A prospect i ve r and omized study was initiated at our institution in 1972 to determine the efficacy of routine elective lymphadenectomy in localized ( stage I ) melanoma . Included in the study were 171 patients , 62 of whom had no lymphadenectomy , 55 of whom had delayed lymphadenectomy , and 54 of whom had immediate lymphadenectomy .  No significant difference was found among the three treatment groups with respect to survival or metastasis-free survival . Multifactorial analysis indicated that the level of invasion and the thickness of the lesion were the most important prognostic factors , followed by age ( 60 years or older ) , site ( legs ) , and tumor type ( nodular ) . A prognostic index based on these variables was highly predictive of metastasis or death . Even when this score was considered , no significant variation was noted among the three treatment groups . More subsequent complications of melanoma , however , occurred in the group with no lymphadenectomy--36 in this group but only 19 in each of the other treatment groups . This finding was not statistically significant but does indicate that a few additional problems may be associated with leaving regional nodes intact . Further studies are needed , and indeed are being conducted , to determine whether elective lymphadenectomy improves survival sufficiently to offset the costs and the complications associated with this approach PURPOSE To compare the effect of pathologic sentinel lymph node ( SLN ) status with that of other known prognostic factors on recurrence and survival in patients with stage I or II cutaneous melanoma . PATIENTS AND METHODS We review ed the records of 612 patients with primary cutaneous melanoma who underwent lymphatic mapping and SLN biopsy between January 1991 and May 1995 to determine the effects of tumor thickness , ulceration , Clark level , location , sex , and SLN pathologic status on disease-free and disease-specific survival . RESULTS In the 580 patients in whom lymphatic mapping and SLN biopsy were successful , the SLN was positive by conventional histology in 85 patients ( 15 % ) but negative in 495 patients ( 85 % ) . SLN status was the most significant prognostic factor with respect to disease-free and disease-specific survival by univariate and multiple covariate analyses . Although tumor thickness and ulceration influenced survival in SLN-negative patients , they provided no additional prognostic information in SLN-positive patients . CONCLUSION Lymphatic mapping and SLN biopsy is highly accurate in staging nodal basins at risk for regional metastases in primary melanoma patients and identifies those who may benefit from earlier lymphadenectomy . Furthermore , pathologic status of the SLN in these patients with clinical ly negative nodes is the most important prognostic factor for recurrence . The information from SLN biopsy is particularly helpful in establishing stratification criteria for future adjuvant trials 
    Output:
    
Sentinel lymph node biopsy and systemic interferon remain promising modalities in the management of melanoma , although there is no affinitive evidence to support their efficacy