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Ann Surg Oncol. 2016 Dec;23(Suppl 5):938-945. Epub 2016 Aug 15.

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

Author information

1
Section of Surgical Oncology, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
2
Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX, USA.
3
Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
4
Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
5
Section of Surgical Oncology, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA. dale.han@yale.edu.

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.

PMID:
27527717
DOI:
10.1245/s10434-016-5502-y
[Indexed for MEDLINE]

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