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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2021

01-02-2021 | Metastasis | Melanoma

Sentinel Lymph Node Biopsy Is Prognostic in Thickest Melanoma Cases and Should Be Performed for Thick Melanomas

Authors: Dale Han, MD, Gang Han, PhD, Monica T. Duque, MPH, Steven Morrison, BA, Stanley P. Leong, MD, Mohammed Kashani-Sabet, MD, John Vetto, MD, Richard White, MD, Schlomo Schneebaum, MD, Barbara Pockaj, MD, Nicola Mozzillo, MD, Vernon K. Sondak, MD, Jonathan S. Zager, MD

Published in: Annals of Surgical Oncology | Issue 2/2021

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Abstract

Background

Sentinel lymph node biopsy (SLNB) is recommended for intermediate thickness melanoma, but for thick melanoma, guidelines are less definitive about the use of SLNB in this population. We present a study on thick melanoma evaluating for prognostic factors.

Patients and Methods

The Sentinel Lymph Node Working Group database was queried for thick (> 4 mm) melanoma cases that had a SLNB from 1993 to 2018. Clinicopathologic characteristics were correlated with SLN status and melanoma-specific survival (MSS).

Results

There were 1235 patients. Median follow-up was 28 months. Median thickness was 5.9 mm, with 956, 175, and 104 cases presenting thickness > 4–8, > 8–12, and > 12 mm, respectively. SLN metastases were seen in 439 of 1235 (35.5%) cases and in 33.9%, 40.6%, and 42.3% of melanomas > 4–8, > 8–12, and > 12 mm, respectively. In each thickness group, MSS was significantly worse for SLN-positive compared with SLN-negative cases (all P < 0.005). Multivariable analysis showed that SLN metastasis, male gender, increasing thickness, lymphovascular invasion, and microsatellitosis significantly predicted worse MSS for melanomas > 4–8 mm, with SLN metastasis showing the greatest risk (HR 2.17, 95% CI 1.64–2.87, P < 0.0001). For melanomas > 8 mm, only SLN metastasis significantly predicted MSS (> 8–12 mm: HR 3.93, 95% CI 2.00–7.73, P < 0.0001; > 12 mm: HR 3.58, 95% CI 1.56–8.22, p < 0.0027).

Conclusions

Thick melanoma patients with SLN metastasis have significantly worse MSS compared with SLN-negative patients, even in the thickest cases, and SLN status is the most powerful and/or only predictor of MSS. Given these results, SLNB shows important prognostic value in this population and is indicated for clinically localized thick melanoma.
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Metadata
Title
Sentinel Lymph Node Biopsy Is Prognostic in Thickest Melanoma Cases and Should Be Performed for Thick Melanomas
Authors
Dale Han, MD
Gang Han, PhD
Monica T. Duque, MPH
Steven Morrison, BA
Stanley P. Leong, MD
Mohammed Kashani-Sabet, MD
John Vetto, MD
Richard White, MD
Schlomo Schneebaum, MD
Barbara Pockaj, MD
Nicola Mozzillo, MD
Vernon K. Sondak, MD
Jonathan S. Zager, MD
Publication date
01-02-2021
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 2/2021
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-08706-0

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