Annals of Surgical Oncology

, Volume 21, Issue 4, pp 1075-1081

First online:

Age as a Predictor of Sentinel Node Metastasis among Patients with Localized Melanoma: An Inverse Correlation of Melanoma Mortality and Incidence of Sentinel Node Metastasis Among Young and Old Patients

  • Charles M. BalchAffiliated withDivision of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center Email author 
  • , John F. ThompsonAffiliated withMelanoma Institute Australia
  • , Jeffrey E. GershenwaldAffiliated withDepartment of Surgical Oncology, The University of Texas MD Anderson Cancer Center
  • , Seng-jaw SoongAffiliated withUniversity of Alabama at Birmingham
  • , Shouluan DingAffiliated withUniversity of Alabama at Birmingham
  • , Kelly M. McMastersAffiliated withDepartment of Surgery, University of Louisville
  • , Daniel G. CoitAffiliated withMemorial Sloan-Kettering Cancer Center
  • , Alexander M. M. EggermontAffiliated withCancer Institute Gustave Roussy
  • , Phyllis A. GimottyAffiliated withDepartment of Biostatistics and Epidemiology, University of Pennsylvania
    • , Timothy M. JohnsonAffiliated withDepartment of Dermatology, University of Michigan Comprehensive Cancer Center
    • , John M. KirkwoodAffiliated withDivision of Oncology, Department of Medicine, University of Pittsburgh School of Medicine
    • , Stanley P. LeongAffiliated withDepartment of Surgery, California Pacific Medical Center and Research Institute
    • , Merrick I. RossAffiliated withDepartment of Surgical Oncology, The University of Texas MD Anderson Cancer Center
    • , David R. ByrdAffiliated withDepartment of Surgery, University of Washington
    • , Alistair J. CochranAffiliated withDepartments of Pathology and Laboratory Medicine and Surgery, UCLA School of Medicine
    • , Martin C. MihmJrAffiliated withDepartment of Pathology, Dana-Farber Cancer Institute
    • , Donald L. MortonAffiliated withJohn Wayne Cancer Institute
    • , Michael B. AtkinsAffiliated withLombardi Comprehensive Cancer Center, Medstar Georgetown University Hospital
    • , Keith T. FlahertyAffiliated withDivision of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital
    • , Vernon K. SondakAffiliated withDivision of Cutaneous Oncology, H. Lee Moffitt Cancer Center

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We have previously reported that older patients with clinical stage I and II primary cutaneous. Melanoma had lower survival rates compared to younger patients. We postulated that the incidence of nodal metastasis would therefore be higher among older melanoma patients.


The expanded American Joint Committee on Cancer melanoma staging database contains a cohort of 7,756 melanoma patients who presented without clinical evidence of regional lymph node or distant metastasis and who underwent a sentinel node biopsy procedure as a component of their staging assessment.


Although older patients had primary melanoma features associated with more aggressive biology, we paradoxically observed a significant decrease in the incidence of sentinel node metastasis as patient age increased. Overall, the highest incidence of sentinel node metastasis was 25.8 % in patients under 20 years of age, compared to 15.5 % in patients 80 years and older (p < 0.001). In contrast, 5-year mortality rates for clinical stage II patients ranged from a low of 20 % for those 20–40 years of age up to 38 % for those over 70 years of age. Patient age was an independent predictor of sentinel node metastasis in a multifactorial analysis (p < 0.001).


Patients with clinical stage I and II melanoma under 20 years of age had a higher incidence of sentinel lymph node metastasis but, paradoxically, a more favorable survival outcome compared to all other age groups. In contrast, patients >70 years had the most aggressive primary melanoma features and a higher mortality rate compared to all other age groups but a lower incidence of sentinel lymph node metastasis.