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The Prognostic Significance of Sentinel Lymph Node Status for Patients with Thick Melanoma

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

Abstract

Background

Sentinel lymph node biopsy (SLNB) is recommended for patients with intermediate-thickness melanoma, but the use of SLNB for patients with thick melanoma is debated. This report presents a single-institution study investigating factors predictive of sentinel lymph node (SLN) metastasis and outcome for thick-melanoma patients .

Methods

A retrospective review of a single-institution database from 1997 to 2012 identified 147 patients with thick primary cutaneous melanoma (≥4 mm) who had an SLNB. Clinicopathologic characteristics were correlated with nodal status and outcome.

Results

The median age of the patients was 67 years, and 61.9 % of the patients were men. The median tumor thickness was 5.5 mm, and 54 patients (36.7 %) had a positive SLN. Multivariable analysis showed that only tumor thickness significantly predicted SLN metastasis (odds ratio 1.14; 95 % confidence interval (CI) 1.02–1.28; P = 0.02). The overall median follow-up period was 34.6 months. Overall survival (OS) and melanoma-specific survival (MSS) were significantly worse for the positive versus negative-SLN patients. Multivariable analysis showed that age [hazard ratio (HR) 1.04; 95 % CI 1.01–1.07; P = 0.02] and SLN status (HR 2.24; 95 % CI 1.03–4.88; P = 0.04) significantly predicted OS, whereas only SLN status (HR 3.85; 95 % CI 2.13–6.97; P < 0.01) significantly predicted MSS.

Conclusions

Tumor thickness predicts SLN status in thick melanomas. Furthermore, SLN status is prognostic for OS and MSS in thick-melanoma patients, with positive-SLN patients having significantly worse OS and MSS. These findings show that SLNB should be recommended for thick-melanoma patients, particularly because detection of SLN metastasis can identify patients for potential systemic therapy and treatment of nodal disease at a microscopic stage.

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Acknowledgment

This project was supported in part by the Ohse Foundation Research Award, Yale University School of Medicine.

Conflict of Interest

An immediate family member of Stephan Ariyan (son) owns stock and is an employee of Pfizer. An immediate family member of Bonnie Gould Rothberg (husband) owns stock and is director of science at Butterfly Networks Inc., LAM Therapeutics, Quantum Si, and Hyperfine Technologies. There are no other conflicts of interest.

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Authors and Affiliations

  1. Section of Surgical Oncology, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA

    Danielle M. Bello MD & Dale Han MD

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

    Gang Han PhD

  3. Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA

    Laura Jackson BS, Kaleigh Bulloch MPH & Bonnie Gould Rothberg MD, PhD

  4. Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA

    Stephan Ariyan MD & Deepak Narayan MD

Authors
  1. Danielle M. Bello MD
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  2. Gang Han PhD
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  3. Laura Jackson BS
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  4. Kaleigh Bulloch MPH
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  5. Stephan Ariyan MD
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  6. Deepak Narayan MD
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  7. Bonnie Gould Rothberg MD, PhD
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  8. Dale Han MD
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Correspondence to Dale Han MD.

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Bello, D.M., Han, G., Jackson, L. et al. The Prognostic Significance of Sentinel Lymph Node Status for Patients with Thick Melanoma. Ann Surg Oncol 23 (Suppl 5), 938–945 (2016). https://doi.org/10.1245/s10434-016-5502-y

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  • DOI: https://doi.org/10.1245/s10434-016-5502-y

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