The Prognostic Significance of Sentinel Lymph Node Status for Patients with Thick Melanoma

Danielle M. Bello, Gang Han, Laura Jackson, Kaleigh Bulloch, Stephan Ariyan, Deepak Narayan, Bonnie Gould Rothberg, Dale Han

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Background: Sentinel lymph node biopsy (SLNB) is recommended for patients with intermediate-thickness melanoma, but the use of SLNB for patients with thick melanoma is debated. This report presents a single-institution study investigating factors predictive of sentinel lymph node (SLN) metastasis and outcome for thick-melanoma patients. Methods: A retrospective review of a single-institution database from 1997 to 2012 identified 147 patients with thick primary cutaneous melanoma (≥4 mm) who had an SLNB. Clinicopathologic characteristics were correlated with nodal status and outcome. Results: The median age of the patients was 67 years, and 61.9 % of the patients were men. The median tumor thickness was 5.5 mm, and 54 patients (36.7 %) had a positive SLN. Multivariable analysis showed that only tumor thickness significantly predicted SLN metastasis (odds ratio 1.14; 95 % confidence interval (CI) 1.02–1.28; P = 0.02). The overall median follow-up period was 34.6 months. Overall survival (OS) and melanoma-specific survival (MSS) were significantly worse for the positive versus negative-SLN patients. Multivariable analysis showed that age [hazard ratio (HR) 1.04; 95 % CI 1.01–1.07; P = 0.02] and SLN status (HR 2.24; 95 % CI 1.03–4.88; P = 0.04) significantly predicted OS, whereas only SLN status (HR 3.85; 95 % CI 2.13–6.97; P < 0.01) significantly predicted MSS. Conclusions: Tumor thickness predicts SLN status in thick melanomas. Furthermore, SLN status is prognostic for OS and MSS in thick-melanoma patients, with positive-SLN patients having significantly worse OS and MSS. These findings show that SLNB should be recommended for thick-melanoma patients, particularly because detection of SLN metastasis can identify patients for potential systemic therapy and treatment of nodal disease at a microscopic stage.

Original languageEnglish (US)
Pages (from-to)938-945
Number of pages8
JournalAnnals of surgical oncology
Volume23
DOIs
StatePublished - Dec 1 2016

ASJC Scopus subject areas

  • Surgery
  • Oncology

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    Bello, D. M., Han, G., Jackson, L., Bulloch, K., Ariyan, S., Narayan, D., Rothberg, B. G., & Han, D. (2016). The Prognostic Significance of Sentinel Lymph Node Status for Patients with Thick Melanoma. Annals of surgical oncology, 23, 938-945. https://doi.org/10.1245/s10434-016-5502-y