Annals of Surgical Oncology

, Volume 21, Issue 11, pp 3386–3394 | Cite as

Sentinel Node Location in Trunk and Extremity Melanomas: Uncommon or Multiple Lymph Drainage Does Not Affect Survival

  • Daniela Gordon
  • Karin E. Smedby
  • Inkeri Schultz
  • Henrik Olsson
  • Christian Ingvar
  • Johan Hansson
  • Peter Gillgren



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.


Sentinel Node Sentinel Lymph Node Biopsy Cutaneous Malignant Melanoma Primary Tumor Site Lymphatic Mapping 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



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.

Supplementary material

10434_2014_3744_MOESM1_ESM.tiff (34 mb)
Supplement 1. Design, inclusion and exclusion criteria. (TIFF 34772 kb)
10434_2014_3744_MOESM2_ESM.tiff (655 kb)
Supplement 2. Anatomic model (SkinTrac©) with primary site of cutaneous melanoma (CM) by multiple (top) and single (bottom) sentinel node location (SNL). (TIFF 655 kb)
10434_2014_3744_MOESM3_ESM.docx (18 kb)
Supplementary material 3 (DOCX 17 kb)


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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Daniela Gordon
    • 1
  • Karin E. Smedby
    • 1
  • Inkeri Schultz
    • 2
    • 3
  • Henrik Olsson
    • 4
  • Christian Ingvar
    • 5
  • Johan Hansson
    • 6
    • 7
  • Peter Gillgren
    • 8
    • 9
  1. 1.Department of Medicine Solna, Clinical Epidemiology UnitKarolinska InstitutetStockholmSweden
  2. 2.Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
  3. 3.Department of Reconstructive Plastic SurgeryKarolinska University HospitalStockholmSweden
  4. 4.Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
  5. 5.Department of Surgery, Clinical SciencesLund University HospitalLundSweden
  6. 6.Department of Oncology and PathologyKarolinska InstitutetStockholmSweden
  7. 7.Department of OncologyKarolinska University HospitalStockholmSweden
  8. 8.Department of Clinical Science and EducationKarolinska InstitutetStockholmSweden
  9. 9.Department of SurgeryStockholm Söder HospitalStockholmSweden

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