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Sentinel Node Location in Trunk and Extremity Melanomas: Uncommon or Multiple Lymph Drainage Does Not Affect Survival

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Patients with cutaneous melanoma (CM) on the trunk have a worse prognosis than those with extremity CM. One reason could be multiple or uncommon (outside axilla or groin) sentinel node locations (SNLs).

Methods

We identified 859 patients who underwent sentinel node biopsy for trunk (n = 465) or extremity (n = 394) CM in three Swedish healthcare regions from 2000 to 2008. We collected patient, tumor, and sentinel node characteristics through clinical registers and medical records. We investigated the distribution of SNLs in a logistic regression model, and risk of overall and melanoma-specific death through 2011 in a multivariable Cox regression model.

Results

Trunk CM was associated with multiple SNLs (31 vs. 7 %; odds ratio [OR] 7.1; 95 % confidence interval [CI] 4.6–11.5; p < 0.001) but not uncommon SNLs (8 vs. 7 %; OR 1.1; 95 % CI 0.6–1.9; p = 0.75) compared with extremity CM. The increased risk of melanoma-specific death was confirmed for trunk CM (hazard ratio [HR] 1.9; 95 % CI 1.3–2.9; p = 0.003), especially on the upper back (HR 2.3; 95 % CI 1.4–3.6; p < 0.001) compared with extremity CM. Uncommon SNLs (HR 0.5; 95 % CI 0.2–1.4; p = 0.21) or multiple SNLs (HR 1.1; 95 % CI 0.4–2.9; p = 0.81) were not associated with melanoma-specific death compared with those with common/single SNL.

Conclusions

Trunk melanomas were associated with multiple lymph drainage, but the worse prognosis of trunk melanomas could not be explained by the increased frequency of multiple or uncommon SNLs.

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Acknowledgment

We are grateful to Assistant Professor Jan Mattson at Sahlgrenska University Hospital, Gothenburg for aid in the collection of data.

Conflict of interest

No conflicts of interest declared. Daniela Gordon is currently receiving a grant from the regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutet. Karin E. Smedby holds a grant from the Strategic Research Program in Epidemiology.

Author information

Authors and Affiliations

  1. Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden

    Daniela Gordon MD & Karin E. Smedby MD, PhD

  2. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

    Inkeri Schultz MD, PhD

  3. Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden

    Inkeri Schultz MD, PhD

  4. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Henrik Olsson MSc

  5. Department of Surgery, Clinical Sciences, Lund University Hospital, Lund, Sweden

    Christian Ingvar MD, PhD

  6. Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden

    Johan Hansson MD, PhD

  7. Department of Oncology, Karolinska University Hospital, Stockholm, Sweden

    Johan Hansson MD, PhD

  8. Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden

    Peter Gillgren MD, PhD

  9. Department of Surgery, Stockholm Söder Hospital, Stockholm, Sweden

    Peter Gillgren MD, PhD

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  1. Daniela Gordon MD
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Corresponding author

Correspondence to Daniela Gordon MD.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplement 1. Design, inclusion and exclusion criteria. (TIFF 34772 kb)

10434_2014_3744_MOESM2_ESM.tiff

Supplement 2. Anatomic model (SkinTrac©) with primary site of cutaneous melanoma (CM) by multiple (top) and single (bottom) sentinel node location (SNL). (TIFF 655 kb)

Supplementary material 3 (DOCX 17 kb)

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Gordon, D., Smedby, K.E., Schultz, I. et al. Sentinel Node Location in Trunk and Extremity Melanomas: Uncommon or Multiple Lymph Drainage Does Not Affect Survival. Ann Surg Oncol 21, 3386–3394 (2014). https://doi.org/10.1245/s10434-014-3744-0

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  • DOI: https://doi.org/10.1245/s10434-014-3744-0

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