Date: 23 May 2012

Sentinel lymph node status as most important prognostic factor in patients with high-risk cutaneous melanomas (tumour thickness >4.00 mm): outcome analysis from a single institution

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Sentinel lymph node biopsy (SLNB) is considered the most powerful prognostic indicator of survival in patients with cutaneous melanoma of intermediate thickness (1–4 mm). The use of SLNB in patients with melanoma with a tumour thickness >4.0 mm is still controversial. The purpose of the current study was to determine the prognostic value of SLNB in patients with thick cutaneous melanomas (tumour thickness >4.0 mm) in terms of progression-free survival (PFS) and overall survival (OS).


A retrospective single-centre study was performed at the Department of Dermatology and Allergy, University of Bonn, and the Department of Nuclear Medicine, University of Bonn, based on data collected between September 2000 and January 2010. A total of 142 patients with cutaneous melanoma of thickness >4.00 mm were identified, and 63 of these patients underwent SLNB.


Of the 63 patients in whom SLNB was performed, 25 (39.7 %) had a positive SLN. Ulceration was more frequent in SLN-positive patients (44 %) than in SLN-negative patients (18.4 %). The mean follow-up time for the 63 patients was 50.7 months. Positive SLN status predicted a significantly reduced life expectancy in the analyses of PFS and OS. In SLN-positive patients 5-year OS was 76 % and in SLN-negative patients was 84.2 % (p = 0.048). Patients with a combination of ulcerated tumour and positive SLN had the worst prognosis.


On the basis of our follow-up data, SLNB has to be recommended in patients with a tumour thickness >4.00 mm after exclusion of lymph node macrometastases or distant metastases. SLN status is the most significant prognostic factor in this group of patients.

Torsten Hinz and Hojjat Ahmadzadehfar contributed equally to this work.