Sentinel Node Location in Trunk and Extremity Melanomas: Uncommon or Multiple Lymph Drainage Does Not Affect Survival
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Patients with cutaneous melanoma (CM) on the trunk have a worse prognosis than those with extremity CM. One reason could be multiple or uncommon (outside axilla or groin) sentinel node locations (SNLs).
We identified 859 patients who underwent sentinel node biopsy for trunk (n = 465) or extremity (n = 394) CM in three Swedish healthcare regions from 2000 to 2008. We collected patient, tumor, and sentinel node characteristics through clinical registers and medical records. We investigated the distribution of SNLs in a logistic regression model, and risk of overall and melanoma-specific death through 2011 in a multivariable Cox regression model.
Trunk CM was associated with multiple SNLs (31 vs. 7 %; odds ratio [OR] 7.1; 95 % confidence interval [CI] 4.6–11.5; p < 0.001) but not uncommon SNLs (8 vs. 7 %; OR 1.1; 95 % CI 0.6–1.9; p = 0.75) compared with extremity CM. The increased risk of melanoma-specific death was confirmed for trunk CM (hazard ratio [HR] 1.9; 95 % CI 1.3–2.9; p = 0.003), especially on the upper back (HR 2.3; 95 % CI 1.4–3.6; p < 0.001) compared with extremity CM. Uncommon SNLs (HR 0.5; 95 % CI 0.2–1.4; p = 0.21) or multiple SNLs (HR 1.1; 95 % CI 0.4–2.9; p = 0.81) were not associated with melanoma-specific death compared with those with common/single SNL.
Trunk melanomas were associated with multiple lymph drainage, but the worse prognosis of trunk melanomas could not be explained by the increased frequency of multiple or uncommon SNLs.
KeywordsSentinel Node Sentinel Lymph Node Biopsy Cutaneous Malignant Melanoma Primary Tumor Site Lymphatic Mapping
We are grateful to Assistant Professor Jan Mattson at Sahlgrenska University Hospital, Gothenburg for aid in the collection of data.
Conflict of interest
No conflicts of interest declared. Daniela Gordon is currently receiving a grant from the regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutet. Karin E. Smedby holds a grant from the Strategic Research Program in Epidemiology.
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