Importance of sentinel lymph node biopsy in patients with thin melanoma.
OBJECTIVE
The status of the sentinel node (SN) confers important prognostic information for patients with thin melanoma.


METHODS
We queried our melanoma database to identify patients undergoing sentinel lymph node biopsy for thin (< or =1.00-mm) cutaneous melanoma at a tertiary care cancer institute. Slides of tumor-positive SNs were reviewed by a melanoma pathologist to confirm nodal status and intranodal tumor burden, defined as isolated tumor cells, micrometastasis, or macrometastasis (< or =0.20, 0.21-2.00, or >2.00 mm, respectively). Nodal status was correlated with patient age and primary tumor depth (< or = 0.25, 0.26-0.50, 0.51-0.75, or 0.76-1.00 mm). Survival was determined by log-rank test.


METHODS
Disease-free and melanoma-specific survival.


RESULTS
Of 1592 patients who underwent sentinel lymph node biopsy from 1991 to 2004, 631 (40%) had thin melanomas; 31 of the 631 patients (5%) had a tumor-positive SN. At a median follow-up of 57 months for the 631 patients, the mean (SD) 10-year rate of disease-free survival was 96% (1%) vs 54% (10%) for patients with tumor-negative vs tumor-positive SNs, respectively (P < .001); the mean (SD) 10-year rate of melanoma-specific survival was 98% (1%) vs 83% (8%), respectively (P < .001). Tumor-positive SNs were more common in patients aged 50 years and younger (P = .04). The SN status maintained importance on multivariate analysis for both disease-free survival (P < .001) and melanoma-specific survival (P < .001).


CONCLUSIONS
The status of the SN is significantly linked to survival in patients with thin melanoma. Therefore, sentinel lymph node biopsy should be considered to obtain complete prognostic information.
Wright
Byron E
BE
Department of Surgical Oncology, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California 90404, USA.
Scheri
Randall P
RP
Ye
Xing
X
Faries
Mark B
MB
Turner
Roderick R
RR
Essner
Richard
R
Morton
Donald L
DL
D000328:Adult; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology*
Ann Surg Oncol. 2005 Jun;12(6):449-58
15864482
Arch Dermatol. 2003 May;139(5):617-21
12756098
Ann Surg. 2003 Oct;238(4):528-35; discussion 535-7
14530724
N Engl J Med. 2006 Sep 28;355(13):1307-17
17005948
Braz J Med Biol Res. 2003 Mar;36(3):347-50
12640499
Ann Surg. 1977 Jul;186(1):101-3
879870
Ann Surg Oncol. 2000 Mar;7(2):87-97
10761786
Ann Surg Oncol. 2004 Oct;11(10):900-6
15383424
Ann Surg Oncol. 2003 Jun;10(5):558-61
12794023
N Engl J Med. 1977 Sep 22;297(12):627-30
895764
Ann Surg. 1975 Jul;182(1):86-91
1147713
J Clin Oncol. 2003 Apr 1;21(7):1326-31
12663722
Curr Treat Options Oncol. 2004 Jun;5(3):185-94
15115647
Ann Surg. 1996 Sep;224(3):255-63; discussion 263-6
8813254
Ann Surg Oncol. 2006 Apr;13(4):533-41
16523360
Clin Adv Hematol Oncol. 2007 Jun;5(6):483-90
17679922
Ann Surg. 2005 Sep;242(3):302-11; discussion 311-3
16135917
Cancer. 1978 Mar;41(3):948-56
638981
Ann Surg Oncol. 2004 Mar;11(3 Suppl):186S-91S
15023749
Eur J Surg Oncol. 2004 Oct;30(8):851-6
15336731
J Dermatol. 2007 Aug;34(8):512-5
17683380
Ann Surg Oncol. 2006 Mar;13(3):302-9
16485151
Ann Surg Oncol. 2007 May;14(5):1596-603
17285396
Cancer. 2003 Sep 15;98(6):1223-31
12973846
Cancer. 1982 Jun 1;49(11):2420-30
7074555
J Clin Oncol. 2004 Sep 15;22(18):3668-76
15302909
Ann Surg Oncol. 2006 Jul;13(7):927-32
16788753
Arch Surg. 1992 Apr;127(4):392-9
1558490
J Clin Oncol. 2008 Jan 10;26(2):258-63
18182666
Surg Clin North Am. 2003 Feb;83(1):109-56
12691453
Curr Opin Oncol. 2006 Mar;18(2):185-8
16462189
Ann Surg. 1977 Aug;186(2):201-9
889365
J Surg Oncol. 2006 Mar 15;93(4):279-85
16496355
Ann Surg. 1999 Oct;230(4):453-63; discussion 463-5
10522715