title: Sentinel lymph node biopsy is prognostic but not therapeutic for thick melanoma.
abstract: BACKGROUND
  Sentinel lymph node biopsy (SNB) as a staging and therapeutic procedure in melanomas 1-4 mm in thickness has been investigated extensively, however, the clinical value of SNB in thick melanomas is poorly understood.
  
  
  METHODS
  Patients undergoing operation for clinically node-negative melanoma >4 mm in depth between 2003 and 2010 were identified in the Surveillance Epidemiology and End Results registry. Two groups were constructed: one with a wide excision with SNB and the other with wide excision alone.
  
  
  RESULTS
  A total of 4,571 patients with clinically node-negative, thick melanoma were identified. The median age was 71 years, 96.9% were white, and 64.3% were male. SNB was performed in 2,746 (60.1%) and was positive in 32.2%. Univariate analysis demonstrated SNB was associated with younger age (64 vs 75 years; P < .001) and extremity primaries (P < .0001). On logistic regression, advanced age (P < .001), female sex (P = .009), and location in the head and neck region (P < .001) were associated with observation. On log-rank analysis, improved 5-year disease-specific survival (DSS) was associated with SNB (65 vs 62%; P = .008), location in the extremity versus head and neck or trunk (67 vs 61.5 and 60.3%; P = .004), female sex (69 vs 61%; P < .001), and no ulceration (74 vs 54%; P < .001). On Cox regression analysis, advanced age (P < .001), male sex (P = .01), trunk location (P = .0001), and ulceration (P < .001) continued to be associated with DSS. SNB was not associated with survival (P = .20). SNB status was a robust predictor of survival; a negative SNB had a 5-year DSS of 75.3 versus 44.1% (P < .0001), with a positive node.
  
  
  CONCLUSIONS
  For patients with clinically node-negative, thick melanoma, SNB is a staging but not therapeutic procedure.
authors.affiliation: The Brody School of Medicine, East Carolina University, Greenville, North Carolina; Division of Surgical Oncology, Department of Surgery, East Carolina University, Greenville, North Carolina.
authors.forename: Swapnil D
authors.initials: SD
authors.lastname: Kachare
authors.affiliation: The Brody School of Medicine, East Carolina University, Greenville, North Carolina.
authors.forename: Patreek
authors.initials: P
authors.lastname: Singla
authors.affiliation: The Brody School of Medicine, East Carolina University, Greenville, North Carolina; Division of Surgical Oncology, Department of Surgery, East Carolina University, Greenville, North Carolina.
authors.forename: Nasreen A
authors.initials: NA
authors.lastname: Vohra
authors.affiliation: The Brody School of Medicine, East Carolina University, Greenville, North Carolina; Division of Surgical Oncology, Department of Surgery, East Carolina University, Greenville, North Carolina.
authors.forename: Emmanuel E
authors.initials: EE
authors.lastname: Zervos
authors.affiliation: The Brody School of Medicine, East Carolina University, Greenville, North Carolina; Division of Surgical Oncology, Department of Surgery, East Carolina University, Greenville, North Carolina.
authors.forename: Jan H
authors.initials: JH
authors.lastname: Wong
authors.affiliation: The Brody School of Medicine, East Carolina University, Greenville, North Carolina; Division of Surgical Oncology, Department of Surgery, East Carolina University, Greenville, North Carolina. Electronic address: fitzgeraldt@ecu.edu.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Fitzgerald
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018426:SEER Program; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult