Original Article

International Journal of Clinical Oncology

, Volume 18, Issue 3, pp 428-434

Sentinel lymph node biopsy for cutaneous melanoma: results of 10 years’ experience in two regional training hospitals in the Netherlands

  • Frank J. van den BroekAffiliated withDepartment of Surgery, Westfries Gasthuis
  • , Pim C. SlootsAffiliated withDepartment of Surgery, Máxima Medical Centre
  • , Jan-Willem D. de WaardAffiliated withDepartment of Surgery, Westfries Gasthuis
  • , Rudi M. RoumenAffiliated withDepartment of Surgery, Máxima Medical Centre Email author 

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Abstract

Background and objective

The Multicenter Selective Lymphadenectomy Trial (MSLT-I) demonstrated that the sentinel node (SN) status in cutaneous melanoma affects prognosis and that completion lymphadenectomy in SN-positive patients may improve survival. Our objective was to evaluate sentinel lymph node biopsy (SLNB) in two regional hospitals in the Netherlands.

Methods

Patients with localized melanoma were planned for wide excision and SLNB. Completion lymphadenectomy was recommended for positive SN status. Data were compared with the MSLT-I.

Results

A median of 2 (1–7) SNs were identified in 305 patients and complications occurred in 11%. Fifty-four patients (18%) demonstrated SN metastases and 45 underwent completion lymphadenectomy (20% additional metastases). Six patients with initially negative SN developed lymph node metastases (sensitivity 90%). Overall disease-free survival was 83% (SN-negative 91% vs. SN-positive 41%; p < 0.001) and melanoma-specific survival was 93% (SN-negative 97% vs. SN-positive 62%; p < 0.001). Multivariate regression analysis revealed the SN status to be the most significant predictor for recurrence and melanoma-related death.

Conclusion

Our results of SLNB are comparable to data from high-volume centers participating in MSLT-I. From a patient perspective, the false-negative SN rate of 10% and complication rate of 11% should be weighed against being informed about prognosis and having a possible therapeutic benefit from completion lymphadenectomy.

Keywords

Melanoma Sentinel lymph node biopsy Neoplasm staging Lymphatic metastasis Survival analysis Skin neoplasms