title: Age as a predictor of sentinel node metastasis among patients with localized melanoma: an inverse correlation of melanoma mortality and incidence of sentinel node metastasis among young and old patients.
abstract: OBJECTIVE
  We have previously reported that older patients with clinical stage I and II primary cutaneous. Melanoma had lower survival rates compared to younger patients. We postulated that the incidence of nodal metastasis would therefore be higher among older melanoma patients.
  
  
  METHODS
  The expanded American Joint Committee on Cancer melanoma staging database contains a cohort of 7,756 melanoma patients who presented without clinical evidence of regional lymph node or distant metastasis and who underwent a sentinel node biopsy procedure as a component of their staging assessment.
  
  
  RESULTS
  Although older patients had primary melanoma features associated with more aggressive biology, we paradoxically observed a significant decrease in the incidence of sentinel node metastasis as patient age increased. Overall, the highest incidence of sentinel node metastasis was 25.8 % in patients under 20 years of age, compared to 15.5 % in patients 80 years and older (p < 0.001). In contrast, 5-year mortality rates for clinical stage II patients ranged from a low of 20 % for those 20-40 years of age up to 38 % for those over 70 years of age. Patient age was an independent predictor of sentinel node metastasis in a multifactorial analysis (p < 0.001).
  
  
  CONCLUSIONS
  Patients with clinical stage I and II melanoma under 20 years of age had a higher incidence of sentinel lymph node metastasis but, paradoxically, a more favorable survival outcome compared to all other age groups. In contrast, patients >70 years had the most aggressive primary melanoma features and a higher mortality rate compared to all other age groups but a lower incidence of sentinel lymph node metastasis.
authors: Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA, balch@asoeditorial.org.
authors: Charles M
authors: CM
authors: Balch
authors: John F
authors: JF
authors: Thompson
authors: Jeffrey E
authors: JE
authors: Gershenwald
authors: Seng-Jaw
authors: SJ
authors: Soong
authors: Shouluan
authors: S
authors: Ding
authors: Kelly M
authors: KM
authors: McMasters
authors: Daniel G
authors: DG
authors: Coit
authors: Alexander M M
authors: AM
authors: Eggermont
authors: Phyllis A
authors: PA
authors: Gimotty
authors: Timothy M
authors: TM
authors: Johnson
authors: John M
authors: JM
authors: Kirkwood
authors: Stanley P
authors: SP
authors: Leong
authors: Merrick I
authors: MI
authors: Ross
authors: David R
authors: DR
authors: Byrd
authors: Alistair J
authors: AJ
authors: Cochran
authors: Martin C
authors: MC
authors: Mihm
authors: Donald L
authors: DL
authors: Morton
authors: Michael B
authors: MB
authors: Atkins
authors: Keith T
authors: KT
authors: Flaherty
authors: Vernon K
authors: VK
authors: Sondak
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000401:mortality* / Q000556:secondary; D015996:Survival Rate; D014481:United States; D055815:Young Adult