Sentinel lymph node staging of cutaneous melanoma: predictors and outcomes.
BACKGROUND
The authors updated their experience with sentinel lymph node (SLN) biopsy of clinically node negative (N0) melanoma to clarify indications, predictive factors, and outcomes.


METHODS
A review of patients from the authors' institution's prospective database (n = 397) was performed; survival statistics were obtained from the institutional tumor registry.


RESULTS
The SLN-positive (SLN+) rate was 16% (47 of 282) for lesions >1 mm thick; only 2 of 105 T1 lesions were SLN+. Thickness >2 mm, upper extremity primary, and ulceration predicted SLN+ status. Most SLN+ patients underwent completion node dissection; 12% had additional positive nodes. The false-negative SLN biopsy rate was 4.0%; the majority involved lower extremity and head and neck primaries. The overall complication rate was 26%; all were minor and resolved within 6 months. Overall 5-year survival rates were 73% and 92% for SLN+ and SLN-negative patients, respectively. SLN status was the most significant predictor of survival.


CONCLUSIONS
SLN status, the most important determinant of outcome for clinically N0 melanoma, correlated with T stage, ulceration, and site. Staging of T1 lesions had low yield. A minority of completion node dissections yielded additional positive nodes.
Ellis
Michelle C
MC
Weerasinghe
Roshanthi
R
Corless
Christopher L
CL
Vetto
John T
JT
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D002648:Child; D016208:Databases, Factual; D018572:Disease-Free Survival; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D011877:Radionuclide Imaging; D012042:Registries; D018570:Risk Assessment; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis; D055815:Young Adult