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The Impact of Smoking on Sentinel Node Metastasis of Primary Cutaneous Melanoma



Although a well-established causative relationship exists between smoking and several epithelial cancers, the association of smoking with metastatic progression in melanoma is not well studied. We hypothesized that smokers would be at increased risk for melanoma metastasis as assessed by sentinel lymph node (SLN) biopsy.


Data from the first international Multicenter Selective Lymphadenectomy Trial (MSLT-I) and the screening-phase of the second trial (MSLT-II) were analyzed to determine the association of smoking with clinicopathologic variables and SLN metastasis.


Current smoking was strongly associated with SLN metastasis (p = 0.004), even after adjusting for other predictors of metastasis. Among 4231 patients (1025 in MSLT-I and 3206 in MSLT-II), current or former smoking was also independently associated with ulceration (p < 0.001 and p < 0.001, respectively). Compared with current smoking, never smoking was independently associated with decreased Breslow thickness in multivariate analysis (p = 0.002) and with a 0.25 mm predicted decrease in thickness.


The direct correlation between current smoking and SLN metastasis of primary cutaneous melanoma was independent of its correlation with tumor thickness and ulceration. Smoking cessation should be strongly encouraged among patients with or at risk for melanoma.

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This study was supported by Grants CA189163 and CA29605 from the National Cancer Institute, and by funding from the Amyx Foundation, Inc. Boise, ID, USA; the Borstein Family Foundation, Los Angeles, CA, USA; Dr Miriam and Sheldon G. Adelson Medical Research Foundation, Boston, MA, USA; and the John Wayne Cancer Institute Auxiliary, Santa Monica, CA, USA. Dr Maris S. Jones is the Harold McAlister Charitable Foundation Fellow. The content of this report is solely the responsibility of the authors and does not necessarily represent the official view of the National Cancer Institute or the National Institutes of Health.

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Correspondence to Mark B. Faries MD.

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Jones, M.S., Jones, P.C., Stern, S.L. et al. The Impact of Smoking on Sentinel Node Metastasis of Primary Cutaneous Melanoma. Ann Surg Oncol 24, 2089–2094 (2017).

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  • Melanoma
  • Sentinel Lymph Node
  • Sentinel Lymph Node Biopsy
  • Sentinel Lymph Node Positivity
  • Sentinel Lymph Node Metastasis