title: Outcome following sentinel node biopsy plus wide local excision versus wide local excision only for primary cutaneous melanoma: analysis of 5840 patients treated at a single institution.
abstract: OBJECTIVE
  Worldwide, sentinel node biopsy (SNB) is now a standard staging procedure for most patients with melanomas 1 mm or more in thickness, but its therapeutic benefit is not clear, pending randomized trial results. This study sought to assess the therapeutic benefit of SNB in a large, nonrandomized patient cohort.
  
  
  METHODS
  Patients with primary melanomas 1.00 mm or more thick or with adverse prognostic features treated with wide local excision (WLE) at a single institution between 1992 and 2008 were identified. The outcomes for those who underwent WLE plus SNB (n = 2909) were compared with the outcomes for patients in an observation (OBS) group who had WLE only (n = 2931). Median follow-up was 42 months.
  
  
  RESULTS
  Melanoma-specific survival (MSS) was not significantly different for patients in the SNB and OBS groups. However, a stratified univariate analysis of MSS for different thickness subgroups indicated a significantly better MSS for SNB patients with T2 and T3 melanomas (>1.0 to 4.0 mm thick) (P = 0.011), but this was not independently significant in multivariate analysis. Compared with OBS patients, SNB patients demonstrated improved disease-free survival (DFS) (P < 0.001) and regional recurrence-free survival (P < 0.001). There was also an improvement in distant metastasis-free survival (DMFS) for SNB patients with T2 and T3 melanomas (P = 0.041).
  
  
  CONCLUSIONS
  In this study, the outcome for the overall cohort after WLE alone did not differ significantly from the outcome after additional SNB. However, the outcome for the subgroup of patients with melanomas more than 1.0 to 4.0 mm in thickness was improved if they had a SNB, with significantly improved disease-free and DMFS.
authors.affiliation: *Melanoma Institute Australia †Sydney Medical School, The University of Sydney, Sydney ‡Nuclear Medicine and Diagnostic Ultrasound, RPAH Medical Centre, Newtown, New South Wales, Australia.
authors.forename: Augustinus P T
authors.initials: AP
authors.lastname: van der Ploeg
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Haydu
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Spillane
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Quinn
authors.forename: Robyn Pm
authors.initials: RP
authors.lastname: Saw
authors.forename: Kerwin F
authors.initials: KF
authors.lastname: Shannon
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Stretch
authors.forename: Roger F
authors.initials: RF
authors.lastname: Uren
authors.forename: Richard A
authors.initials: RA
authors.lastname: Scolyer
authors.forename: John F
authors.initials: JF
authors.lastname: Thompson
mesh_terms: D062109:Dermatologic Surgical Procedures / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D012878:Skin Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D000096142:Cutaneous Malignant Melanoma