Annals of Surgical Oncology

, Volume 21, Issue 4, pp 1075–1081

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


    • Division of Surgical Oncology, Department of SurgeryUniversity of Texas Southwestern Medical Center
  • John F. Thompson
    • Melanoma Institute Australia
  • Jeffrey E. Gershenwald
    • Department of Surgical OncologyThe University of Texas MD Anderson Cancer Center
  • Seng-jaw Soong
    • University of Alabama at Birmingham
  • Shouluan Ding
    • University of Alabama at Birmingham
  • Kelly M. McMasters
    • Department of SurgeryUniversity of Louisville
  • Daniel G. Coit
    • Memorial Sloan-Kettering Cancer Center
  • Alexander M. M. Eggermont
    • Cancer Institute Gustave Roussy
  • Phyllis A. Gimotty
    • Department of Biostatistics and EpidemiologyUniversity of Pennsylvania
  • Timothy M. Johnson
    • Department of DermatologyUniversity of Michigan Comprehensive Cancer Center
  • John M. Kirkwood
    • Division of Oncology, Department of MedicineUniversity of Pittsburgh School of Medicine
  • Stanley P. Leong
    • Department of SurgeryCalifornia Pacific Medical Center and Research Institute
  • Merrick I. Ross
    • Department of Surgical OncologyThe University of Texas MD Anderson Cancer Center
  • David R. Byrd
    • Department of SurgeryUniversity of Washington
  • Alistair J. Cochran
    • Departments of Pathology and Laboratory Medicine and SurgeryUCLA School of Medicine
  • Martin C. MihmJr
    • Department of PathologyDana-Farber Cancer Institute
  • Donald L. Morton
    • John Wayne Cancer Institute
  • Michael B. Atkins
    • Lombardi Comprehensive Cancer CenterMedstar Georgetown University Hospital
  • Keith T. Flaherty
    • Division of Hematology/Oncology, Department of MedicineMassachusetts General Hospital
  • Vernon K. Sondak
    • Division of Cutaneous OncologyH. Lee Moffitt Cancer Center

DOI: 10.1245/s10434-013-3464-x

Cite this article as:
Balch, C.M., Thompson, J.F., Gershenwald, J.E. et al. Ann Surg Oncol (2014) 21: 1075. doi:10.1245/s10434-013-3464-x



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.

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© Society of Surgical Oncology 2014