title: Utility of sentinel lymph node biopsy for solitary dermal melanomas.
abstract: OBJECTIVE
  Solitary dermal melanoma (SDM) is melanoma confined to subcutaneous and/or dermal layers in the absence of a known primary cutaneous lesion. We hypothesized that sentinel node biopsy is an effective staging strategy for this rare disease.
  
  
  METHODS
  A Markov decision model was constructed to represent two management strategies for SDM: wide local excision followed by observation, and wide local excision followed by sentinel node biopsy. Utilities, likelihood of positive sentinel node biopsy, and cancer progression rates during a five year time horizon were assigned based on institutional data and a review of existing literature. Estimated costs were derived using Medicare reimbursements.
  
  
  RESULTS
  Excision followed by sentinel node biopsy provides greater utility, yielding 3.85 discounted quality-adjusted life years (dQALY) compared to 3.66 for excision alone. The incremental cost-effectiveness ratio for sentinel node biopsy is $19,102 per dQALY. Sensitivity analyzes demonstrated that observation is more cost-effective if greater than 23% of sentinel node biopsies are positive (16% reported), or if 5-year survival for observed patients is greater than 76% (69% reported).
  
  
  CONCLUSIONS
  Based on existing clinical evidence, sentinel node biopsy yields greater utility than excision alone and is cost-effective for patients presenting with solitary dermal melanoma.
authors.affiliation: Department of Surgery/Division of Surgical Oncology, Charlottesville, Virginia.
authors.forename: Yinin
authors.initials: Y
authors.lastname: Hu
authors.forename: Puja
authors.initials: P
authors.lastname: Shah
authors.forename: George J
authors.initials: GJ
authors.lastname: Stukenborg
authors.forename: Craig L
authors.initials: CL
authors.lastname: Slingluff
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000191:economics / Q000401:mortality*; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000191:economics / Q000706:statistics & numerical data*; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D000096142:Cutaneous Malignant Melanoma
keywords: cost-effectiveness; decision analysis; melanoma; sentinel node biopsy; solitary dermal melanoma