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Sentinel Lymph Node Biopsy Is Prognostic in Thickest Melanoma Cases and Should Be Performed for Thick Melanomas

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

Abstract

Background

Sentinel lymph node biopsy (SLNB) is recommended for intermediate thickness melanoma, but for thick melanoma, guidelines are less definitive about the use of SLNB in this population. We present a study on thick melanoma evaluating for prognostic factors.

Patients and Methods

The Sentinel Lymph Node Working Group database was queried for thick (> 4 mm) melanoma cases that had a SLNB from 1993 to 2018. Clinicopathologic characteristics were correlated with SLN status and melanoma-specific survival (MSS).

Results

There were 1235 patients. Median follow-up was 28 months. Median thickness was 5.9 mm, with 956, 175, and 104 cases presenting thickness > 4–8, > 8–12, and > 12 mm, respectively. SLN metastases were seen in 439 of 1235 (35.5%) cases and in 33.9%, 40.6%, and 42.3% of melanomas > 4–8, > 8–12, and > 12 mm, respectively. In each thickness group, MSS was significantly worse for SLN-positive compared with SLN-negative cases (all P < 0.005). Multivariable analysis showed that SLN metastasis, male gender, increasing thickness, lymphovascular invasion, and microsatellitosis significantly predicted worse MSS for melanomas > 4–8 mm, with SLN metastasis showing the greatest risk (HR 2.17, 95% CI 1.64–2.87, P < 0.0001). For melanomas > 8 mm, only SLN metastasis significantly predicted MSS (> 8–12 mm: HR 3.93, 95% CI 2.00–7.73, P < 0.0001; > 12 mm: HR 3.58, 95% CI 1.56–8.22, p < 0.0027).

Conclusions

Thick melanoma patients with SLN metastasis have significantly worse MSS compared with SLN-negative patients, even in the thickest cases, and SLN status is the most powerful and/or only predictor of MSS. Given these results, SLNB shows important prognostic value in this population and is indicated for clinically localized thick melanoma.

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Funding

This work was not supported by any funding source.

Author information

Authors and Affiliations

  1. Division of Surgical Oncology, Oregon Health and Science University, Portland, OR, USA

    Dale Han MD, Steven Morrison BA & John Vetto MD

  2. Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX, USA

    Gang Han PhD & Monica T. Duque MPH

  3. California Pacific Medical Center and Research Institute, San Francisco, CA, USA

    Stanley P. Leong MD & Mohammed Kashani-Sabet MD

  4. Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA

    Richard White MD

  5. Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel

    Schlomo Schneebaum MD

  6. Mayo Clinic, Phoenix, AZ, USA

    Barbara Pockaj MD

  7. Instituto Tumori Napoli Fondazione G. Pascale, Naples, Italy

    Nicola Mozzillo MD

  8. Moffitt Cancer Center, Tampa, FL, USA

    Vernon K. Sondak MD & Jonathan S. Zager MD

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  1. Dale Han MD
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Corresponding author

Correspondence to Dale Han MD.

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Disclosures

Dr. Sondak (V.K.S.) reports being a paid consultant to Array, BMS, Merck, Pfizer, Polynoma, Regeneron, and Replimune. Dr. Zager (J.S.Z.) reports having research funding from Amgen, Castle Biosciences, Delcath Systems, Novartis, Provectus, and Philogen, being on the medical advisory board for Delcath Systems, the speakers’ bureau for Sun Pharma, Array Biopharma/Pfizer, and Castle Biosciences, in addition to consulting for Merck, Sanofi/Regeneron, Amgen, and Sun Pharma. All other authors report no conflicts.

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Han, D., Han, G., Duque, M.T. et al. Sentinel Lymph Node Biopsy Is Prognostic in Thickest Melanoma Cases and Should Be Performed for Thick Melanomas. Ann Surg Oncol 28, 1007–1016 (2021). https://doi.org/10.1245/s10434-020-08706-0

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  • DOI: https://doi.org/10.1245/s10434-020-08706-0

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