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Sentinel Node Biopsy is Indicated for Thin Melanomas ≥0.76 mm

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

A consensus for which patients with thin melanomas (≤1 mm) should undergo sentinel lymph node biopsy (SLNB) is not established. We describe a large single institution experience with SLNB for thin melanomas to determine factors predictive of nodal metastases.

Methods

Retrospective review from 2005 to 2010 identified 271 patients with thin melanomas who underwent SLNB, along with 13 additional patients not treated with SLNB who developed a nodal recurrence as first site of recurrence. Clinicopathologic characteristics were correlated with nodal status and outcome.

Results

Median age was 55 years, and 53 % of patients were male. Median Breslow thickness was 0.85 mm. Overall, a positive sentinel lymph node (SLN) was found in 22 (8.1 %) of 271 cases; 8.4 % of melanomas ≥0.76 mm were SLN positive with 5 % of T1a melanomas ≥0.76 mm and 13 % of T1b melanomas ≥0.76 mm having SLN metastases. Only two of 33 highly selected patients with melanomas <0.76 mm (both T1b) had a positive SLN. Logistic regression analysis demonstrated that mitotic rate ≥1/mm2 significantly correlated with nodal disease (p < 0.05) and ulceration correlated with SLN metastases (p < 0.05). Median follow-up was 2.1 years. Overall survival did not differ between positive and negative SLN patients (p = 0.53) but was worse for patients presenting with a nodal recurrence (p < 0.01).

Conclusions

SLN metastases were seen in 8.4 % of thin melanomas ≥0.76 mm, including 5 % of T1a melanomas ≥0.76 mm. We believe these rates are sufficient to justify consideration of SLNB in these patients, while the indications for SLNB in melanomas <0.76 mm remain to be defined.

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Disclosures

V.K.S.: Consultant/Advisory Board: Merck, Navidea (Neoprobe); J.S.Z.: Consultant/Scientific Advisory Board: Delcath Systems Inc., Consultant/Advisory Board: IGEA; J.L.M.: Consultant: Glaxo Smith Kline, Consultant: Durect Corporation.

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Authors and Affiliations

  1. Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA

    Dale Han MD, Suroosh S. Marzban MS, Jane L. Messina MD, Ricardo J. Gonzalez MD, C. Wayne Cruse MD, Amod A. Sarnaik MD, Christopher Puleo PA-C, Vernon K. Sondak MD & Jonathan S. Zager MD

  2. Department of Biostatistics, Moffitt Cancer Center, Tampa, FL, USA

    Daohai Yu PhD & Xiuhua Zhao MPH

  3. Departments of Oncologic Sciences, Pathology, and Dermatology, University of South Florida Morsani College of Medicine, Tampa, FL, USA

    Jane L. Messina MD

  4. Departments of Oncologic Sciences and Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA

    Ricardo J. Gonzalez MD, Amod A. Sarnaik MD, Vernon K. Sondak MD & Jonathan S. Zager MD

  5. Departments of Oncologic Sciences and Plastic Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA

    C. Wayne Cruse MD

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  1. Dale Han MD
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  2. Daohai Yu PhD
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Correspondence to Jonathan S. Zager MD.

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Han, D., Yu, D., Zhao, X. et al. Sentinel Node Biopsy is Indicated for Thin Melanomas ≥0.76 mm. Ann Surg Oncol 19, 3335–3342 (2012). https://doi.org/10.1245/s10434-012-2469-1

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  • DOI: https://doi.org/10.1245/s10434-012-2469-1

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