title: Sentinel node status predicts survival in thick melanomas: the Oxford perspective.
abstract: OBJECTIVE
  To determine the prognostic value of SLNB in patients with thick melanoma in terms of overall survival (OS) and recurrence-free survival (RFS).
  
  
  METHODS
  136 patients with primary tumours (Breslow thickness ≥ 4.0 mm) underwent SLNB. OS and RFS were calculated and a multivariate Cox regression model used to determine the important prognostic factors for predicting OS and RFS.
  
  
  RESULTS
  Median Breslow thickness was 5.5 mm and 60% were ulcerated. Median follow up was 4 years (95% CI = 4-5) with 54 patients having died at the time of analysis. 5-year OS for SLNB positive patients was 32%, compared to 78% for negative patients. The significant predictors of poorer OS were increasing age (p = 0.03), increasing Breslow thickness (p = 0.03) and SLNB positivity (p < 0.0001). 5 year RFS was significantly worse in the SLNB positive population compared to the negative patients (p < 0.0001); 27% versus 66% respectively.
  
  
  CONCLUSIONS
  Patients with a thick melanoma and a positive SLNB have a significantly worse RFS and OS compared to those with a negative SLNB. Over three-quarters of patients with a negative SLNB survived five years. These findings have implications for the subpopulations included in adjuvant therapy trials and we advocate SLNB be recommended in patients with thick melanomas.
authors.affiliation: Department of Plastic & Reconstructive Surgery, Oxford University Hospitals, Oxford OX3 9DU, UK. mrughani@doctors.org.uk
authors.forename: M G
authors.initials: MG
authors.lastname: Rughani
authors.forename: M C
authors.initials: MC
authors.lastname: Swan
authors.forename: T S
authors.initials: TS
authors.lastname: Adams
authors.forename: A
authors.initials: A
authors.lastname: Marshall
authors.forename: R
authors.initials: R
authors.lastname: Asher
authors.forename: O C
authors.initials: OC
authors.lastname: Cassell
authors.forename: M R
authors.initials: MR
authors.lastname: Middleton
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016001:Confidence Intervals; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D021701:Sentinel Lymph Node Biopsy / Q000379:methods / Q000706:statistics & numerical data*; D012737:Sex Factors; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult