Annals of Surgical Oncology

, Volume 23, Issue 13, pp 4178–4188 | Cite as

Sentinel Lymph Node Biopsy in Thin Cutaneous Melanoma: A Systematic Review and Meta-Analysis

  • Erin CordeiroEmail author
  • Mai-Kim Gervais
  • Prakesh S. Shah
  • Nicole J. Look Hong
  • Frances C. Wright



Most patients with melanoma have a thin (≤1.00 mm) lesion. There is uncertainty as to which patients with thin melanoma should undergo sentinel lymph node (SN) biopsy. We sought to quantify the proportion of SN metastases in patients with thin melanoma and to determine the pooled effect of high-risk features of the primary lesion on SN positivity.


Published literature between 1980 and 2015 was searched and critically appraised. Primary outcome was the proportion of SN metastases in patients with thin cutaneous melanoma. Secondary outcomes included the effect of high-risk pathological features of the primary lesion on the proportion of SN metastases. Summary measures were estimated by Mantel–Haenszel method using random effects meta-analyses.


Sixty studies (10,928 patients) met the criteria for inclusion. Pooled SN positivity was 4.5 % [95 % confidence interval (CI) 3.8–5.2 %]. Predictors of a positive SN were: thickness ≥0.75 mm [adjusted odds ratio (AOR) 1.90 (95 % CI 1.08–3.34); with a likelihood of SN metastases of 8.8 % (95 % CI 6.4–11.2 %)]; Clark level IV/V [AOR 2.24 (95 % CI 1.23–4.08); with a likelihood of 7.3 % (95 % CI 6.2–8.4 %)]; ≥1 mitoses/mm2 [AOR 6.64 (95 % CI 2.77–15.88); pooled likelihood 8.8 % (95 % CI 6.2–11.4 %)]; and the presence of microsatellites [unadjusted OR 6.94 (95 % CI 2.13–22.60); likelihood 26.6 % (95 % CI 4.3–48.9 %)].


The pooled proportion of SN metastases in thin melanoma is 4.5 %. Thickness ≥0.75 mm, Clark level IV/V, mitoses, and microsatellites significantly increased the odds of SN positivity and should prompt strong consideration of SN biopsy.


Melanoma Sentinel Lymph Node Sentinel Lymph Node Biopsy Sentinel Lymph Node Positivity Sentinel Lymph Node Metastasis 
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 work was supported in part by the Al Hertz Melanoma Research Grant. The study sponsor had no role in the design, collection, analysis, interpretation of the data, writing of the manuscript, or the decision to submit the manuscript. Prakesh Shah is supported by an Applied Research Chair in Reproductive and Child Health Services and Policy Research by the Canadian Institute of Health Research. The authors thank Ms. Elizabeth Uleryk for her assistance with the literature search and Dr. Nathan Lamond for assistance with the manuscript.


The authors have no relevant financial disclosures.


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Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Erin Cordeiro
    • 1
    Email author
  • Mai-Kim Gervais
    • 2
  • Prakesh S. Shah
    • 3
    • 4
  • Nicole J. Look Hong
    • 2
    • 5
  • Frances C. Wright
    • 2
    • 5
  1. 1.Division of General SurgeryThe Ottawa HospitalOttawaCanada
  2. 2.Department of SurgeryUniversity of TorontoTorontoCanada
  3. 3.Department of PaediatricsMount Sinai HospitalTorontoCanada
  4. 4.Department of PaediatricsUniversity of TorontoTorontoCanada
  5. 5.Division of General SurgerySunnybrook Health Sciences CentreTorontoCanada

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