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The natural history of thin melanoma and the utility of sentinel lymph node biopsy
Author(s) -
Durham Alison B.,
Schwartz Jennifer L.,
Lowe Lori,
Zhao Lili,
Johnson Andrew G.,
Harms Kelly L.,
Bichakjian Christopher K.,
Orsini Amy P.,
McLean Scott A.,
Bradford Carol R.,
Cohen Mark S.,
Johnson Timothy M.,
Sabel Michael S.,
Wong Sandra L.
Publication year - 2017
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24765
Subject(s) - medicine , melanoma , sentinel lymph node , breslow thickness , biopsy , wide local excision , natural history , surgery , radiology , cancer , breast cancer , cancer research
Background and Objectives Current literature may overestimate the risk of nodal metastasis from thin melanoma due to reporting of data only from lesions treated with SLNB. Our objective was to define the natural history of thin melanoma, assessing the likelihood of nodal disease, in order to guide selection for SLNB. Methods Retrospective review. The primary outcome was the rate of nodal disease. Clinicopathologic factors were evaluated to find associations with nodal disease. Results Five hundred and twelve lesions, follow up available for 488 (median: 48 months). Lesions treated with WLE/SLNB compared to WLE alone were more likely to have high‐risk features. The rate of nodal disease was higher in the WLE/SLNB group (24 positive SLNB, five false‐negative SLNB with nodal recurrence: 10.2%) compared to WLE alone (four nodal recurrences: 2.0%). Univariate analysis showed age ≤45, Breslow depth ≥0.85 mm, mitotic rate >1 mm 2 , and ulceration were associated with nodal disease. Multivariate analysis confirmed the association of age ≤45 and ulceration. Conclusions SLNB for melanoma 0.75‐0.99 mm should be considered in patients age ≤45, Breslow depth ≥0.85 mm, mitotic rate >1 mm 2 , and/or with ulceration. Thin melanoma <0.85 mm without high‐risk features may be treated with WLE alone.