title: The effect of delay time between primary melanoma biopsy and sentinel lymph node dissection on sentinel node status, recurrence, and survival.
abstract: For primary melanoma, there is a delay between the initial skin biopsy and sentinel lymph node dissection, which may cause anxiety for the patient. The consequences of this delay on disease progression are unknown. The goal of this study was to determine whether delay time for sentinel node dissection from the initial cutaneous melanoma biopsy affects patient outcomes. A retrospective analysis of 492 patients with melanoma who underwent a sentinel node dissection between 1993 and 1999 was carried out. The endpoints assessed were sentinel node tumor status, recurrence, and mortality. Time to sentinel node dissection was compared between patients with positive and negative sentinel nodes. Long-term survival and recurrence were evaluated in relation to the time between the cutaneous biopsy and the sentinel node dissection (delay time), comparing less than 40 days with at least 40 days. In total, 15.9% of patients had positive sentinel nodes. The median follow-up was 11.7 years. Positive sentinel node patients had a median delay of 35 days between the primary melanoma biopsy and the sentinel node dissection compared with 41 days for negative sentinel node patients (P=0.5). Kaplan-Meier survival curves showed that a delay time of less than 40 days versus at least 40 days was not related to recurrence of melanoma (log-rank P=0.13) or overall survival (log-rank P=0.14). On multivariate analysis of age, thickness, ulceration, and sentinel node status, there was no difference in disease-free survival (P=0.58) or overall survival (P=0.53) between the less than 40 days and the at least 40 days groups. A modest delay in sentinel node dissection from the initial melanoma biopsy does not adversely affect sentinel node status, recurrence, nor survival.
authors.affiliation: The Buncke Clinic, Plastic Surgery, California Pacific Medical Center, San Francisco, CA 94115, USA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Parrett
authors.forename: Neil A
authors.initials: NA
authors.lastname: Accortt
authors.forename: Rui
authors.initials: R
authors.lastname: Li
authors.forename: Amarjit S
authors.initials: AS
authors.lastname: Dosanjh
authors.forename: Suresh
authors.initials: S
authors.lastname: Thummala
authors.forename: Raj
authors.initials: R
authors.lastname: Kullar
authors.forename: James E
authors.initials: JE
authors.lastname: Cleaver
authors.forename: Mohammed
authors.initials: M
authors.lastname: Kashani-Sabet
authors.forename: Stanley P L
authors.initials: SP
authors.lastname: Leong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods*; D002648:Child; D018450:Disease Progression; D006801:Humans; D008545:Melanoma / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery*; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult