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Sentinel lymph node biopsy is indicated for patients with thick clinically lymph node‐negative melanoma
Author(s) -
Yamamoto Maki,
Fisher Kate J.,
Wong Joyce Y.,
Koscso Jonathan M.,
Konstantinovic Monique A.,
Govsyeyev Nicholas,
Messina Jane L.,
Sarnaik Amod A.,
Cruse C. Wayne,
Gonzalez Ricardo J.,
Sondak Ver K.,
Zager Jonathan S.
Publication year - 2015
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.29239
Subject(s) - medicine , sentinel lymph node , melanoma , biopsy , lymph , lymph node , surgery , breslow thickness , radiology , cancer , pathology , breast cancer , cancer research
BACKGROUND Sentinel lymph node biopsy (SLNB) is indicated for the staging of clinically lymph node‐negative melanoma of intermediate thickness, but its use is controversial in patients with thick melanoma. METHODS From 2002 to 2012, patients with melanoma measuring ≥4 mm in thickness were evaluated at a single institution. Associations between survival and clinicopathologic characteristics were explored. RESULTS Of 571 patients with melanomas measuring ≥4 mm in thickness and no distant metastases, the median age was 66 years and 401 patients (70.2%) were male. The median Breslow thickness was 6.2 mm; the predominant subtype was nodular (45.4%). SLNB was performed in 412 patients (72%) whereas 46 patients (8.1%) presented with clinically lymph node‐positive disease and 113 patients (20%) did not undergo SLNB. A positive SLN was found in 161 of 412 patients (39.1%). For SLNB performed at the study institution, 14 patients with a negative SLNB developed disease recurrence in the mapped lymph node basin (false‐negative rate, 12.3%). The median disease‐specific survival (DSS), overall survival (OS), and recurrence‐free survival (RFS) for the entire cohort were 62.1 months, 42.5 months, and 21.2 months, respectively. The DSS and OS for patients with a negative SLNB were 82.4 months and 53.4 months, respectively; 41.2 months and 34.7 months, respectively, for patients with positive SLNB; and 26.8 months and 22 months, respectively, for patients with clinically lymph node‐positive disease ( P <.0001). The median RFS was 32.4 months for patients who were SLNB negative, 14.3 months for patients who were SLNB positive, and 6.8 months for patients with clinically lymph node‐positive disease ( P <.0001). CONCLUSIONS With an acceptably low false‐negative rate, patients with thick melanoma and a negative SLNB appear to have significantly prolonged RFS, DSS, and OS compared with those with a positive SLNB. Therefore, SLNB should be considered as indicated for patients with thick, clinically lymph node‐negative melanoma. Cancer 2015;121:1628–1636 . © 2015 American Cancer Society .