title: Sentinel lymph node biopsy is indicated for patients with thick clinically lymph node-negative melanoma.
abstract: BACKGROUND
  Sentinel lymph node biopsy (SLNB) is indicated for the staging of clinically lymph node-negative melanoma of intermediate thickness, but its use is controversial in patients with thick melanoma.
  
  
  METHODS
  From 2002 to 2012, patients with melanoma measuring ≥4 mm in thickness were evaluated at a single institution. Associations between survival and clinicopathologic characteristics were explored.
  
  
  RESULTS
  Of 571 patients with melanomas measuring ≥4 mm in thickness and no distant metastases, the median age was 66 years and 401 patients (70.2%) were male. The median Breslow thickness was 6.2 mm; the predominant subtype was nodular (45.4%). SLNB was performed in 412 patients (72%) whereas 46 patients (8.1%) presented with clinically lymph node-positive disease and 113 patients (20%) did not undergo SLNB. A positive SLN was found in 161 of 412 patients (39.1%). For SLNB performed at the study institution, 14 patients with a negative SLNB developed disease recurrence in the mapped lymph node basin (false-negative rate, 12.3%). The median disease-specific survival (DSS), overall survival (OS), and recurrence-free survival (RFS) for the entire cohort were 62.1 months, 42.5 months, and 21.2 months, respectively. The DSS and OS for patients with a negative SLNB were 82.4 months and 53.4 months, respectively; 41.2 months and 34.7 months, respectively, for patients with positive SLNB; and 26.8 months and 22 months, respectively, for patients with clinically lymph node-positive disease (P<.0001). The median RFS was 32.4 months for patients who were SLNB negative, 14.3 months for patients who were SLNB positive, and 6.8 months for patients with clinically lymph node-positive disease (P<.0001).
  
  
  CONCLUSIONS
  With an acceptably low false-negative rate, patients with thick melanoma and a negative SLNB appear to have significantly prolonged RFS, DSS, and OS compared with those with a positive SLNB. Therefore, SLNB should be considered as indicated for patients with thick, clinically lymph node-negative melanoma.
authors: Division of Surgical Oncology, Department of Surgery, University of California at Irvine Medical Center, Orange, California.
authors: Maki
authors: M
authors: Yamamoto
authors: Kate J
authors: KJ
authors: Fisher
authors: Joyce Y
authors: JY
authors: Wong
authors: Jonathan M
authors: JM
authors: Koscso
authors: Monique A
authors: MA
authors: Konstantinovic
authors: Nicholas
authors: N
authors: Govsyeyev
authors: Jane L
authors: JL
authors: Messina
authors: Amod A
authors: AA
authors: Sarnaik
authors: C Wayne
authors: CW
authors: Cruse
authors: Ricardo J
authors: RJ
authors: Gonzalez
authors: Vernon K
authors: VK
authors: Sondak
authors: Jonathan S
authors: JS
authors: Zager
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery*; D055815:Young Adult
keywords: Breslow depth; false-negative rate; melanoma; sentinel lymph node biopsy; thick melanoma