title: Sentinel lymph node biopsy status is a key parameter to stratify the prognostic heterogeneity of malignant melanoma in high-risk tumors >4.0 mm.
abstract: BACKGROUND
  The value of sentinel lymph node biopsy (SLNB) as a useful strategy to assess the risk of future metastasis in high-risk melanomas (>4.0 mm) is controversially discussed.
  
  
  OBJECTIVE
  In a single-center retrospective study, the prognostic relevance of SLNB and other risk factors in the subgroup of melanomas >4.0 mm was investigated and compared to previously published results.
  
  
  METHODS
  Using Kaplan-Meier estimates and Cox regressions, we assessed the prognostic relevance of SLNB in our subcohort of 87 patients with thick melanomas >4.0 mm (T4). The mean follow-up for this subgroup was 51 months. We compared SLN value as compared to ulceration.
  
  
  RESULTS
  SLN and ulceration, analyzed as separate risk factors as well as their combination, predicted a highly reduced life expectancy in terms of recurrence-free survival (RFS) in our cohort of patients. SLN, but not ulceration, also predicted overall survival (OS).
  
  
  CONCLUSIONS
  Positive SLNB is an essential predictor of RFS and OS in T4 melanoma patients, whereas ulceration lacked significance with respect to OS in our cohort. Our data thus suggest the routine use of SLNB also for T4 melanoma and may therefore allow to optimize risk-stratified therapeutic regimens.
authors.affiliation: Department of Dermatology and Venereology, Otto von Guericke University, Magdeburg, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Göppner
authors.forename: Jens
authors.initials: J
authors.lastname: Ulrich
authors.forename: Anna
authors.initials: A
authors.lastname: Pokrywka
authors.forename: Brigitte
authors.initials: B
authors.lastname: Peters
authors.forename: Harald
authors.initials: H
authors.lastname: Gollnick
authors.forename: Martin
authors.initials: M
authors.lastname: Leverkus
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology* / Q000556:secondary*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology*; D012883:Skin Ulcer / Q000473:pathology*; D015996:Survival Rate; D055815:Young Adult