title: The sentinel node biopsy in patients with thick melanoma: outcome analysis from a single-institution database.
abstract: BACKGROUND
  We examined the impact of sentinel lymph node (SLN) biopsy among patients with primary melanoma that exceeded 4.0 mm in Breslow thickness, treated in our Institution from 1998 until 2009.
  
  
  METHODS
  According to Kaplan-Meier statistics, overall survival (OS) and disease-free survival (DFS) were assessed in patients with: i) disseminated disease at diagnosis with respect to patients undergoing SLN biopsy and ii) positive SLN and negative SLN. The effect of age, thickness and number of positive SLN on survival was also calculated.
  
  
  RESULTS
  Forty-three patients with thick melanoma were included (29 men and 14 women; mean age 65 ± 17 years, tumor thickness ranging from 4 to 20 mm). Thirteen patients (30%) were not eligible for SLN biopsy due to metastatic disease or poor clinical condition. Biopsy was performed on 30 patients: 14 with positive SLN (46.7%, group A) and 16 with negative SLN (53.3%, group B). Seven patients (50%) died in group A and 2 patients (13%) in group B (mean follow-up 28 and 59 months, respectively); all 7 patients in group A and no patient in group B died because of melanoma. OS and DFS were both significantly higher in group B than group A.
  
  
  CONCLUSIONS
  Our experience demonstrates a high rate of positive SLNs in patients with thick melanoma, and significant differences regarding the general outcomes between those with positive and negative SLNs, the latter group having a good prognosis despite the thick primary tumor. This observation stresses the importance of SLN biopsy as a staging tool in patients with thick melanoma.
authors.affiliation: Department of Surgery, University of Perugia, 06100 Perugia, Italy. piero.covarelli@med.unipg.it
authors.forename: P
authors.initials: P
authors.lastname: Covarelli
authors.forename: M C
authors.initials: MC
authors.lastname: Vedovati
authors.forename: C
authors.initials: C
authors.lastname: Becattini
authors.forename: F
authors.initials: F
authors.lastname: Rondelli
authors.forename: G M
authors.initials: GM
authors.lastname: Tomassini
authors.forename: S
authors.initials: S
authors.lastname: Messina
authors.forename: G
authors.initials: G
authors.lastname: Noya
authors.forename: G
authors.initials: G
authors.lastname: Bistoni
authors.forename: S
authors.initials: S
authors.lastname: Simonetti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D008875:Middle Aged; D021701:Sentinel Lymph Node Biopsy; D016019:Survival Analysis; D016896:Treatment Outcome