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Using the Merlin assay for reducing sentinel lymph node biopsy complications in melanoma: a retrospective cohort study
Author(s) -
Hieken Tina J.,
Sadurní Mariana B.,
Quattrocchi Enrica,
Kobic Ajdin,
SominidiDamodaran Sindhuja,
Dwarkasing Jvalini T.,
MeersteinKessel Lisette,
Bridges Alina G.,
Meves Alexander
Publication year - 2022
Publication title -
international journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 93
eISSN - 1365-4632
pISSN - 0011-9059
DOI - 10.1111/ijd.16056
Subject(s) - medicine , seroma , sentinel lymph node , lymphedema , surgery , complication , cellulitis , biopsy , lymphadenectomy , lymph node , radiology , cancer , breast cancer
Background The assessment of the sentinel lymph node is a cornerstone of melanoma staging. However, ~80% of sentinel lymph node biopsies (SLNB) are negative and nontherapeutic, and patients are unnecessarily exposed to surgery‐related complications. Here, we gauged the potential of the Merlin assay to reduce SLNB‐associated complications. The Merlin assay uses clinicopathologic variables and tumor gene expression profiling to identify low‐risk patients who may forgo SLNB. Methods We utilized the Merlin test development cohort to determine SLNB complication rates for procedures performed between 2004 and 2018 at Mayo Clinic. Complications evaluated were lymphedema, seroma, infection/cellulitis, hematoma, and wound dehiscence. Patients who underwent a completion lymph node dissection were excluded. Results A total of 558 patients were included. The overall 90‐day complication rate specific to SLNB (1 year for lymphedema) was 17.4%. The most common complications were seroma (9.3%), infection/cellulitis (4.8%), and lymphedema (4.3%). All three were more common in patients with a lower extremity primary tumor location versus other locations. With Merlin test results applied, SLNB‐related complications would have decreased by 59%. Conclusion SLNB is a safe procedure but carries a significant complication rate. Merlin testing might reduce the need for SLNB and its associated complications.