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Surgery. 2015 Sep;158(3):662-8. doi: 10.1016/j.surg.2015.05.012. Epub 2015 Jun 19.

Sentinel lymph node biopsy is prognostic but not therapeutic for thick melanoma.

Author information

1
The Brody School of Medicine, East Carolina University, Greenville, North Carolina; Division of Surgical Oncology, Department of Surgery, East Carolina University, Greenville, North Carolina.
2
The Brody School of Medicine, East Carolina University, Greenville, North Carolina.
3
The Brody School of Medicine, East Carolina University, Greenville, North Carolina; Division of Surgical Oncology, Department of Surgery, East Carolina University, Greenville, North Carolina. Electronic address: fitzgeraldt@ecu.edu.

Abstract

BACKGROUND:

Sentinel lymph node biopsy (SNB) as a staging and therapeutic procedure in melanomas 1-4 mm in thickness has been investigated extensively, however, the clinical value of SNB in thick melanomas is poorly understood.

METHODS:

Patients undergoing operation for clinically node-negative melanoma >4 mm in depth between 2003 and 2010 were identified in the Surveillance Epidemiology and End Results registry. Two groups were constructed: one with a wide excision with SNB and the other with wide excision alone.

RESULTS:

A total of 4,571 patients with clinically node-negative, thick melanoma were identified. The median age was 71 years, 96.9% were white, and 64.3% were male. SNB was performed in 2,746 (60.1%) and was positive in 32.2%. Univariate analysis demonstrated SNB was associated with younger age (64 vs 75 years; P < .001) and extremity primaries (P < .0001). On logistic regression, advanced age (P < .001), female sex (P = .009), and location in the head and neck region (P < .001) were associated with observation. On log-rank analysis, improved 5-year disease-specific survival (DSS) was associated with SNB (65 vs 62%; P = .008), location in the extremity versus head and neck or trunk (67 vs 61.5 and 60.3%; P = .004), female sex (69 vs 61%; P < .001), and no ulceration (74 vs 54%; P < .001). On Cox regression analysis, advanced age (P < .001), male sex (P = .01), trunk location (P = .0001), and ulceration (P < .001) continued to be associated with DSS. SNB was not associated with survival (P = .20). SNB status was a robust predictor of survival; a negative SNB had a 5-year DSS of 75.3 versus 44.1% (P < .0001), with a positive node.

CONCLUSION:

For patients with clinically node-negative, thick melanoma, SNB is a staging but not therapeutic procedure.

PMID:
26096561
DOI:
10.1016/j.surg.2015.05.012
[Indexed for MEDLINE]

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