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The Association of Guideline-Concordant Sentinel Lymph Node Biopsy for Melanoma at Minority-Serving Hospitals

  • Melanoma
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Minority-serving hospitals (MSHs) have been associated with lower guideline adherence and worse outcomes for various cancers. However, the relationship among MSH status, concordance with sentinel lymph node biopsy (SLNB) guidelines, and overall survival (OS) for patients with cutaneous melanoma is not well studied.

Methods

The National Cancer Database was queried for patients diagnosed with T1a*, T2, and T3 melanoma between 2012 and 2017. MSHs were defined as the top decile of institutions ranked by the proportion of minorities treated for melanoma. Based on National Comprehensive Cancer Network guidelines, guideline-concordant care (GCC) was defined as not undergoing SLNB if thickness was < 0.76 mm without ulceration, mitosis ≥ 1/mm2, or lymphovascular invasion (T1a*), and performing SLNB for patients with intermediate thickness melanomas between 1.0 and 4.0 mm (T2/T3). Multivariable logistic regressions examined associations with GCC. The Kaplan–Meier method and log-rank tests were used to evaluate OS between MSH and non-MSH facilities.

Results

Overall, 5.9% (N = 2182/36,934) of the overall cohort and 37.8% of minorities (n = 199/527) were managed at MSHs. GCC rates were 89.5% (n = 33,065/36,934) in the overall cohort and 85.4% (n = 450/527) in the minority subgroup. Patients in the overall cohort (odds ratio [OR] 0.85; p = 0.02) and the minority subgroup (OR 0.55; p = 0.02) were less likely to obtain GCC if they received their care at MSHs compared with non-MSHs. Minority patients receiving care at MSHs had a decreased survival compared with those treated at non-MSHs (p = 0.002).

Conclusions

Adherence to SLNB guidelines for melanoma was lower at MSHs. Continued focus is needed on equity in melanoma care for minority patients in the United States.

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Authors and Affiliations

  1. Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA

    Alicia C. Greene DO, William G. Wong DO, Rolfy A. Perez Holguin MD, Akshilkumar Patel MD & Chan Shen PhD

  2. Division of Surgical Oncology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA

    Colette R. Pameijer MD, FACS

  3. Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA, USA

    Chan Shen PhD

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  1. Alicia C. Greene DO
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Correspondence to Chan Shen PhD.

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Disclosures

Alicia C. Greene, William G. Wong, Rolfy A. Perez Holguin, Akshilkumar Patel, Colette R. Pameijer, and Chan Shen have no relevant financial support, conflicts of interest, or commercial interests to disclose.

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Appendix

Appendix

See Fig. 3.

Fig 3
figure 3

A International Classification of Diseases (ICD-O-3) primary site codes used in the study. B Patient inclusion and exclusion criteria. ALND axillary lymph node dissection, SLNB sentinel lymph node biopsy

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Greene, A.C., Wong, W.G., Perez Holguin, R.A. et al. The Association of Guideline-Concordant Sentinel Lymph Node Biopsy for Melanoma at Minority-Serving Hospitals. Ann Surg Oncol 30, 3634–3645 (2023). https://doi.org/10.1245/s10434-023-13341-6

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