Sentinel lymph node status is the most important prognostic factor for thick (> or = 4 mm) melanomas.
BACKGROUND
The value of the status of the sentinel lymph node (SLN) in patients with thick melanomas (Breslow thickness > or = 4 mm) is controversial.


METHODS
Using Kaplan-Meier estimates and Cox regression models, we studied 152 patients with primary melanomas > or = 4 mm thickness who underwent sentinel lymph node excision (SLNE) at the university hospitals of Hannover and Göttingen, Germany, between 1998 and 2006.


RESULTS
The median tumor thickness was 5.2 (4-18) mm; 58.5% of primary melanomas were ulcerated. Micrometastasis to a SLN was found in 48.7%. The patients with positive SLNs were significantly younger than those with negative SLN (p = 0.01). Of the complete lymph node dissections, 32% contained positive non-SLN. The estimated 5 year recurrence-free survival was 42.5 +/- 5% (+/- standard error) (26.3 +/- 6.6% after positive SLNE, 58.7 +/- 7.1% after negative SLNE). The 5 year overall survival rate was 53.2 +/- 5.4% (37.5 +/- 8.1% after positive SLNE, 67.6 +/- 6.7% after negative SLNE). By multivariate analysis, the SLN was a highly significant predictor for overall survival (p = 0.007, relative risk 2.3, 95%, confidence interval 1.2-4.2). The overall survival was significantly associated with penetration of nodal metastases into the SLN > 0.3 mm (p = 0.001). Other parameters such as tumor thickness, ulceration, age and sex were not significant. In the subgroup of patients with negative SLN, neither tumor thickness nor ulceration was significant.


CONCLUSIONS
The status of the SLN represents the most important prognostic parameter in patients with thick melanomas, whereas other parameters such as tumor thickness and ulceration loose their prognostic value.
Gutzmer
Ralf
R
Department of Dermatology and Venereology, Skin Tumor Center Hannover (HTZH), Hannover Medical School, Hannover, Germany. gutzmer.ralf@mh-hannover.de
Satzger
Imke
I
Thoms
Kai-Martin
KM
Völker
Bernward
B
Mitteldorf
Christina
C
Kapp
Alexander
A
Bertsch
Hans Peter
HP
Kretschmer
Lutz
L
D000368:Aged; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008545:Melanoma / Q000453:epidemiology / Q000473:pathology* / Q000556:secondary*; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000706:statistics & numerical data*; D012878:Skin Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000556:secondary*; D016019:Survival Analysis; D015996:Survival Rate