title: Prognostic information from sentinel lymph node biopsy in patients with thick melanoma.
abstract: OBJECTIVE
  Sentinel lymph node (SLN) biopsy provides valuable prognostic information for patients with thick (T4) melanoma.
  
  
  METHODS
  Post hoc analysis of data from a prospective, randomized trial.
  
  
  METHODS
  Academic and private hospitals.
  
  
  METHODS
  Data of 240 patients with melanoma thicker than 4 mm were analyzed. Patients with tumor-positive SLNs underwent completion lymphadenectomy. Disease-free and overall survival were evaluated by Kaplan-Meier analysis. Univariate and multivariate analyses were performed to evaluate factors predictive of tumor-positive SLNs and disease-free and overall survival.
  
  
  RESULTS
  Median thickness of melanoma was 5.6 mm, and patients were followed up for a median of 50 months. The SLNs were tumor positive in 100 patients (41.7%); 18% of these had additional positive nodes on completion lymphadenectomy. Extremity tumor location (risk ratio, 1.66; 95% confidence interval, 1.24-2.24; P = .001), Clark level (1.95; 1.33-2.87; P = .02), and lymphovascular invasion (1.57; 1.13-2.17; P = .01) were associated with a greater risk of tumor-positive SLNs. The patients with tumor-negative SLNs had significantly better median disease-free survival (46.5 vs 31.0 months; P = .04) and overall survival (55.5 vs 43.0 months; P = .004) compared with patients with tumor-positive SLNs. On multivariate analysis, male sex (risk ratio, 1.59; 95% confidence interval, 1.05-2.50; P = .02), increasing Breslow thickness (1.58; 1.10- 2.30; P = .03), ulceration (1.73; 1.18-2.59; P = .02), and tumor-positive SLNs (1.68; 1.17-2.43; P = .009) were associated with worse overall survival.
  
  
  CONCLUSIONS
  The SLN biopsy provides useful prognostic information for patients with T4 melanoma.
authors.affiliation: Department of Surgery, University of Louisville, 315 E Broadway, Louisville, KY 40202, USA. charles.scoggins@louisville.edu
authors.forename: Charles R
authors.initials: CR
authors.lastname: Scoggins
authors.forename: Adrianne L
authors.initials: AL
authors.lastname: Bowen
authors.forename: Robert C
authors.initials: RC
authors.lastname: Martin
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Edwards
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Reintgen
authors.forename: Merrick I
authors.initials: MI
authors.lastname: Ross
authors.forename: Marshall M
authors.initials: MM
authors.lastname: Urist
authors.forename: Arnold J
authors.initials: AJ
authors.lastname: Stromberg
authors.forename: Lee
authors.initials: L
authors.lastname: Hagendoorn
authors.forename: Kelly M
authors.initials: KM
authors.lastname: McMasters
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009656:North America; D011237:Predictive Value of Tests; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery