How do you approach melanoma patients with a positive sentinel node with extra-nodal extension for definitive surgical management?

This is a multidisciplinary question so I reached out to our surgical oncologist (Dr. @Dr. First Last) at the Ohio State University Comprehensive Cancer Center for his thoughts as well. This is a grey area as the patients with extra-nodal extension (ENE) were not specifically studied in the landmark MSLT-2 study (Faries et al., PMID 28591523). In fact, the MSLT-2 trial did not directly stratify based on or even comment on the role of ENE. However, there were no other clinical/pathologic features...