A nomogram to identify high-risk melanoma patients with a negative sentinel lymph node biopsy

J Am Acad Dermatol. 2019 Mar;80(3):722-726. doi: 10.1016/j.jaad.2018.10.060. Epub 2018 Nov 2.

Abstract

Background: Melanoma patients with negative nodes after sentinel lymph node biopsy are a heterogeneous group. Current guidelines fail to adequately stratify surveillance and treatment for this group. Also, there is scarce data on adjuvant treatments for these patients.

Objective: To create a nomogram including clinical and pathologic characteristics capable of evaluating the risk for recurrence of primary melanoma patients with negative sentinel lymph node biopsies (SLNBs).

Methods: We used a retrospective cohort of patients who underwent SLNB during 2000-2015 at a single institution.

Results: Our cohort comprised 1213 patients. Among these patients, 967 (79.7%) had a negative SLNB, and mean follow-up was 59.67 months. There were 133 recurrences (13.8%); 45 (33.8%) presented with nodal recurrence, and 35 (26.3%) recurred where a SLNB was performed. Breslow thickness, ulceration, and microsatellitosis were found to be predictive of risk for recurrence at 1, 2, 5, and 10 years.

Limitation: Single center analysis.

Conclusion: We created a predictive nomogram for melanoma patients with negative SLNBs. This nomogram is easy to use and identifies high-risk patients who should have more strict surveillance and be considered for adjuvant treatment.

Keywords: melanoma; nomograms; recurrence; sentinel lymph node biopsy.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Humans
  • Lymphatic Metastasis
  • Male
  • Melanoma / complications
  • Melanoma / secondary*
  • Middle Aged
  • Nomograms*
  • Retrospective Studies
  • Risk Assessment / methods
  • Risk Factors
  • Sentinel Lymph Node / pathology
  • Sentinel Lymph Node Biopsy
  • Skin Neoplasms / complications
  • Skin Neoplasms / pathology*
  • Skin Ulcer / etiology
  • Tumor Burden
  • Young Adult