A 10-year analysis of primary cutaneous malignant melanoma with sentinel lymph node biopsy and long-term follow-up.
BACKGROUND
Sentinel lymph node biopsy (SLNB) is an important tool for accurate staging of patients with melanoma. There is an ongoing debate whether the procedure provides therapeutic benefits or not.


OBJECTIVE
We wanted to analyze 10-year data from an academic teaching hospital.


METHODS
During 1999-2009, 977 patients with early cutaneous melanoma have been treated. Of these, 419 patients had tumors ≥ 1 mm thickness. Patients with head and neck tumors were excluded, leaving 364 patients (202 men and 162 women). SLNB was not performed in 163 patients but was performed in 201 patients. For correction of bias, tumors >4 mm thickness were excluded from further statistical analysis.


RESULTS
The detection rate of SLN was 94.4%. False negative SLN were observed in 8.9%. Adverse effects occurred in 5.5%. The rate of positive SLNB was 16.4% and lymph node involvement 20%. Patients undergoing SLNB had a lower relapse rate (10.6% vs. 33.3%; P < 0.001). The most important finding is an almost 50% lower total death rate and melanoma-related death rate in the SLNB subgroup (P < 0.001 for both).


CONCLUSIONS
Sentinel lymph node biopsy is an accurate instrument for melanoma staging to detect occult regional lymph node involvement. Data suggest a positive effect on relapse-free survival. The observation of improved long-term survival needs validation in prospective multicenter trials. The limitations of this study were that it was a single center retrospective analysis.
Department/Institutes of the Academic Teaching Hospital, Dresden-Friedrichstadt, Dresden, Germany.
Josefine
J
Beger
Gesina
G
Hansel
Claudia
C
Krönert
Martin
M
Fuchs
Carmen
C
Tanner
Jaqueline
J
Schönlebe
Carmen
C
Werner
Andreas
A
Nowak
Gunter
G
Haroske
Helmut
H
Witzigmann
Uwe
U
Wollina
D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D012008:Recurrence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects / Q000592:standards*; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D055815:Young Adult