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Use and Costs of Sentinel Lymph Node Biopsy in Non-Ulcerated T1b Melanoma: Analysis of a Population-Based Registry

  • Melanoma
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The utility of sentinel lymph node biopsy (SLNB) for non-ulcerated T1b melanoma is debated and associated costs are poorly characterized. Prior work using institutional registries may overestimate the incidence of nodal positivity in this population.

Objective

The aim of this study was to estimate the use of SLNB, positivity prevalence, and procedural costs in patients with non-ulcerated T1b melanoma using a population-based registry.

Methods

We identified patients with clinically node-negative, non-ulcerated melanoma 0.8–1.0 mm thick (T1b according to the 8th edition standard of the American Joint Committee on Cancer) in the Surveillance, Epidemiology, and End Results database from 2010 to 2016. The prevalence of SLNB procedures and positive sentinel nodes were calculated. Factors associated with SLNB and sentinel node positivity were assessed using logistic regression. Medicare reimbursement costs and patient out-of-pocket expenses for SLNB and wide local excision (WLE) versus WLE alone were estimated.

Results

Among 7245 included patients, 3835(53%) underwent SLNB, 156 (4.1%, 95% confidence interval 3.5–4.7) of whom had a positive SLNB. Younger age, >1 mitosis per mm2, female sex, and truncal tumor location were associated with higher odds of positivity. The estimated SLNB cost to identify one patient with stage III disease was $71,700 (range $54,648–$83,172). Out-of-pocket expenses for a Medicare patient were estimated to be $652 for a WLE and SLNB and $79 for a WLE alone.

Conclusions

In this population-based study, only 4% of selected non-ulcerated T1b patients had a positive SLNB, which is lower than prior reports. At the population level, SLNB is associated with high costs per prognostic information gained.

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Acknowledgment

Joshua N. Herb, David W. Ollila, Karyn B. Stitzenberg, and Michael O. Meyers have no commercial interests to report. Joshua N. Herb is supported by a National Research Service Award Pre-Doctoral/Post-Doctoral Traineeship from the Agency for Healthcare Research and Quality sponsored by the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Grant No. 5T32 HS000032.

Funding

Joshua N. Herb is supported by a National Research Service Award Pre-Doctoral/Post-Doctoral Traineeship from the Agency for Healthcare Research and Quality sponsored by the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Grant No. 5T32 HS000032.

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Joshua N. Herb MD, David W. Ollila MD, FACS, Karyn B. Stitzenberg MD, MPH, FACS & Michael O. Meyers MD, FACS

  2. Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Joshua N. Herb MD

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Herb, J.N., Ollila, D.W., Stitzenberg, K.B. et al. Use and Costs of Sentinel Lymph Node Biopsy in Non-Ulcerated T1b Melanoma: Analysis of a Population-Based Registry. Ann Surg Oncol 28, 3470–3478 (2021). https://doi.org/10.1245/s10434-021-09998-6

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  • DOI: https://doi.org/10.1245/s10434-021-09998-6

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