Annals of Surgical Oncology

, Volume 22, Issue 6, pp 1967–1973 | Cite as

Sentinel Lymph Node Biopsy in Thick-Melanoma Patients (N=350): What is Its Prognostic Role?

  • S. RiberoEmail author
  • S. Osella-Abate
  • M. Sanlorenzo
  • E. Balagna
  • R. Senetta
  • M.T. Fierro
  • G. Macripò
  • L. Macrì
  • A. Sapino
  • P. Quaglino



Sentinel lymph node biopsy (SLNB) is currently recommended for patients with intermediate-thickness melanomas (T2–T3). Historically, T4 melanoma patients have not been considered good candidates for SLNB because of the high risk of distant progression. However, some authors suggest that T4 melanoma patients could be considered as a heterogeneous group that could benefit from SLNB.


We retrospectively analyzed 350 patients with thick (>4 mm) melanomas between 1999 and 2011. Patients were stratified into three groups depending on the results of SLNB: (1) 94 SLNB-negative; (2) 84 SLNB-positive; and (3) 172 SLNB not performed (observation group). The associations of clinical-pathologic features with the result of SLNB, disease-free interval (DFI), and disease-specific survival (DSS) were analyzed.


Multivariate analyses confirmed a better prognosis for SLN-negative patients compared with patients in the observation group (DSS hazard ratio [HR] 0.62, p = 0.03; DFI HR 0.47, p < 0.001). The observation group was shown to have the same prognosis as the positive-sentinel lymph node group, when adjusted for principal confounders in the model.


We confirmed that thick-melanoma patients are a heterogeneous group with different prognosis. In our experience, SLNB allowed for an appropriate stratification of patients in different survival groups. On the basis of our results, we strongly recommend the routine execution of SLNB in cases of primary melanoma thicker than 4 mm.


Melanoma Sentinel Lymph Node Sentinel Lymph Node Biopsy Primary Melanoma Observation Group 
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.



This study was supported by the Lanzavecchia-Lastretti Foundation for “Progetto Melanoma” (Rebecca Senetta). The authors thank Nick Clements for the language revision.


Simone Ribero, Simona Osella-Abate, Martina Sanlorenzo, Elena Balagna, Rebecca Senetta, Maria Teresa Fierro, Giuseppe Macripò, Luigia Macrì, Anna Sapino, and Pietro Quaglino declare no conflicts of interest.

Supplementary material

10434_2014_4211_MOESM1_ESM.docx (26 kb)
Supplementary material 1 (DOCX 26 kb)


  1. 1.
    Morton DL, Thompson JF, Cochran AJ, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355(13):1307–17.CrossRefPubMedGoogle Scholar
  2. 2.
    Morton DL, Thompson JF, Cochran AJ, et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med. 2014;370(7):599–609.CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    van der Ploeg AP, Haydu LE, Spillane AJ, et al. Outcome following sentinel node biopsy plus wide local excision versus wide local excision only for primary cutaneous melanoma: analysis of 5,840 patients treated at a single institution. Ann Surg. 2014;260(1):149–57. doi:  10.1097/SLA.0000000000000500.CrossRefPubMedGoogle Scholar
  4. 4.
    Gershenwald JE, Mansfield PF, Lee JE, Ross MI. Role for lymphatic mapping and sentinel lymph node biopsy in patients with thick (>4 mm) primary melanoma. Ann Surg Oncol. 2000;7:160–65.CrossRefPubMedGoogle Scholar
  5. 5.
    Essner R, Chung MH, Bleicher R, Hsueh E, Wanek L, Morton DL. Prognostic implications of thick (≥ 4 mm) melanoma in the era of intraoperative lymphatic mapping and sentinel lymphadenectomy. Ann Surg Oncol. 2002;9:754–61.PubMedGoogle Scholar
  6. 6.
    Ferrone CR, Panageas KS, Busam K, Brady MS, Coit DG. Multivariate prognostic model for patients with thick cutaneous melanoma: importance of sentinel lymph node status. Ann Surg Oncol. 2002;9:637–45.CrossRefPubMedGoogle Scholar
  7. 7.
    Gajdos C, Griffith KA, Wong SL, et al. Is there a benefit to sentinel lymph node biopsy in patients with T4 melanoma? Cancer. 2009;115:5752–60.CrossRefPubMedGoogle Scholar
  8. 8.
    Salti GI, Kansagra A, Warso MA, Ronan SG, Das Gupta TK. Clinical node-negative thick melanoma. Arch Surg. 2002;137:291–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Thompson JF, Shaw HM. The prognosis of patients with thick primary melanomas: is regional lymph node status relevant, and does removing positive regional nodes influence outcome? Ann Surg Oncol. 2002;9:719–22.CrossRefPubMedGoogle Scholar
  10. 10.
    Carlson GW, Murray DR, Hestley A, Staley CA, Lyles RH, Cohen C. Sentinel lymph node mapping for thick (≥4 mm) melanoma: should we be doing it? Ann Surg Oncol. 2003;10:408–15.CrossRefPubMedGoogle Scholar
  11. 11.
    Caracò C, Celentano E, Lastoria S, Botti G, Ascierto PA, Mozzillo N. Sentinel lymph node biopsy does not change melanoma-specific survival among patients with Breslow thickness greater than four millimeters. Ann Surg Oncol. 2004;11(Suppl 3):198S–202S.CrossRefPubMedGoogle Scholar
  12. 12.
    Jacobs IA, Chang CK, Salti GI. Role of sentinel lymph node biopsy in patients with thick (> 4 mm) primary melanoma. Am Surg. 2004;70:59–62.PubMedGoogle Scholar
  13. 13.
    Cecchi R, Buralli L, Innocenti S, Seghieri G, De Gaudio C. Sentinel lymph node biopsy in patients with thick (≥4 mm) melanoma: a single- centre experience. J Eur Acad Dermatol Venereol. 2007;21:758–61.CrossRefPubMedGoogle Scholar
  14. 14.
    Nowecki ZI, Rutkowski P, Michej W. The survival benefit to patients with positive sentinel node melanoma after completion lymph node dissection may be limited to the subgroup with a primary lesion Breslow thickness greater than 1.0 and less than or equal to 4 mm (pT2–pT3). Ann Surg Oncol. 2008;15: 2223–4.CrossRefPubMedGoogle Scholar
  15. 15.
    Scoggins CR, Bowen AL, Martin RC 2nd, et al. Prognostic information from sentinel lymph node biopsy in patients with thick melanoma. Arch Surg. 2010;145(7):622–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Rondelli F, Vedovati MC, Becattini C, et al. Prognostic role of sentinel node biopsy in patients with thick melanoma: a meta-analysis. J Eur Acad Dermatol Venereol. 2012;26(5):560–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Mozzillo N, Pennacchioli E, Gandini S, et al. Sentinel node biopsy in thin and thick melanoma. Ann Surg Oncol. 2013;20(8):2780–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Wong SL, Balch CM, Hurley P, et al. Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology joint clinical practice guideline. J Clin Oncol. 2012;30(23):2912–18.CrossRefPubMedGoogle Scholar
  19. 19.
    Balch CM, Gershenwald JE, Soong SJ, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27(36):6199–06.CrossRefPubMedCentralPubMedGoogle Scholar
  20. 20.
    Quaglino P, Ribero S, Osella-Abate S, et al. Clinico-pathologic features of primary melanoma and sentinel lymph node predictive for non-sentinel lymph node involvement and overall survival in melanoma patients: a single centre observational cohort study. Surg Oncol. 2011;20(4):259–64.CrossRefPubMedGoogle Scholar
  21. 21.
    Ribero S, Quaglino P, Osella-Abate S, et al. Relevance of multiple basin drainage and primary histologic regression in prognosis of trunk melanoma patients with negative sentinel lymph nodes. J Eur Acad Dermatol Venereol. 2013;27(9):1132–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Savoia P, Fava P, Caliendo V, et al. Disease progression in melanoma patients with negative sentinel lymph node: does false-negative specimens entirely account for this phenomenon? J Eur Acad Dermatol Venereol. 2012;26(2):242–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Dubois RW, Swetter SM, Atkins M, et al. Developing indications for the use of sentinel lymph node biopsy and adjuvant high-dose interferon alfa-2b in melanoma. Arch Dermatol. 2001;137(9):1217–24.CrossRefPubMedGoogle Scholar
  24. 24.
    Eggermont AM, Suciu S, Testori A, et al. Ulceration and stage are predictive of interferon efficacy in melanoma: results of the phase III adjuvant trials EORTC 18952 and EORTC 18991. Eur J Cancer. 2012;48(2):218–25.CrossRefPubMedGoogle Scholar
  25. 25.
    Bernengo MG, Quaglino P, Cappello N, et al. Time course and pattern of first relapse in stage I–II primary cutaneous melanoma: a multivariate analysis of disease-free survival in 3,174 patients followed-up at the Turin Melanoma Centre from 1975 to 2004. G Ital Dermatol Venereol. 2005;140:191–200.Google Scholar
  26. 26.
    Quaglino P, Borgognoni L, Bottoni U, et al. Italian guidelines for staging and follow-up of stage I-II cutaneous melanoma patients. G Ital Dermatol Venereol. 2007;142:41–7.Google Scholar
  27. 27.
    Garbe C, Hauschild A, Volkenandt M, et al. Evidence and interdisciplinary consensus-based German guidelines: surgical treatment and radiotherapy of melanoma. Melanoma Res. 2008;18:61–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Rughani MG, Swan MC, Adams TS, et al. Sentinel node status predicts survival in thick melanomas: the Oxford perspective. Eur J Surg Oncol. 2012;38(10):936–42.CrossRefPubMedGoogle Scholar
  29. 29.
    Cintolo JA, Gimotty P, Blair A, et al. Local immune response predicts survival in patients with thick (t4) melanomas. Ann Surg Oncol. 2013;20(11):3610–17.CrossRefPubMedGoogle Scholar
  30. 30.
    Ribero S, Osella-Abate S, Sanlorenzo M, et al. Favourable prognostic role of regression of primary melanoma in AJCC stage I-II patients. Br J Dermatol. 2013;169(6):1240–45.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • S. Ribero
    • 1
    • 2
    Email author
  • S. Osella-Abate
    • 1
    • 3
  • M. Sanlorenzo
    • 1
  • E. Balagna
    • 2
  • R. Senetta
    • 3
  • M.T. Fierro
    • 1
  • G. Macripò
    • 2
  • L. Macrì
    • 4
  • A. Sapino
    • 3
    • 4
  • P. Quaglino
    • 1
  1. 1.Section of Dermatology, Department of Medical SciencesUniversity of TurinTurinItaly
  2. 2.Section of Dermatologic Surgery, Department of Oncology and HaematologyCittà della Salute e della Scienza di Torino HospitalTurinItaly
  3. 3.Section of Surgical Pathology, Department of Medical SciencesUniversity of TurinTurinItaly
  4. 4.Department of Laboratory DiagnosticAOU Città della Salute e della Scienza di TorinoTurinItaly

Personalised recommendations