The interval between primary melanoma excision and sentinel node biopsy is not associated with survival in sentinel node positive patients - An EORTC Melanoma Group study.
BACKGROUND
Worldwide, sentinel node biopsy (SNB) is the recommended staging procedure for stage I/II melanoma. Most melanoma guidelines recommend re-excision plus SNB as soon as possible after primary excision. To date, there is no evidence to support this timeframe.


OBJECTIVE
To determine melanoma specific survival (MSS) for time intervals between excisional biopsy and SNB in SNB positive patients.


METHODS
Between 1993 and 2008, 1080 patients were diagnosed with a positive SNB in nine Melanoma Group centers. We selected 1015 patients (94%) with known excisional biopsy date. Time interval was calculated from primary excision until SNB. Kaplan-Meier estimated MSS was calculated for different cutoff values. Multivariable analysis was performed to correct for known prognostic factors.


RESULTS
Median age was 51 years (Inter Quartile Range (IQR) 40-62 years), 535 (53%) were men, 603 (59%) primary tumors were located on extremities. Median Breslow thickness was 3.00 mm (IQR 1.90-4.80 mm), 442 (44%) were ulcerated. Median follow-up was 36 months (IQR 20-62 months). Median time interval was 47 days (IQR 32-63 days). Median Breslow thickness was equal for both <47 days and ≥47 days interval: 3.00 mm (1.90-5.00 mm) vs 3.00 mm (1.90-4.43 mm) (p = 0.402). Sentinel node tumor burden was significantly higher in patients operated ≥47 days (p = 0.005). Univariate survival was not significantly different for median time interval. Multivariable analysis confirmed that time interval was no independent prognostic factor for MSS.


CONCLUSIONS
Time interval from primary melanoma excision until SNB was no prognostic factor for MSS in this SNB positive cohort. This information can be used to counsel patients.
Department of Surgical Oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands. Electronic address: c.oudeophuis@erasmusmc.nl.
C M C
CM
Oude Ophuis
Department of Surgical Oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands. Electronic address: c.verhoef@erasmusmc.nl.
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C
Verhoef
Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, ul. W.K. Roentgena 5, 02-781 Warsaw, Poland. Electronic address: rutkowskip@coi.waw.pl.
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P
Rutkowski
Melanoma Unit, St. George's Foundation University Hospital, Blakshaw Road, Tooting, London SW17 0QT, United Kingdom. Electronic address: bpowell@sgul.ac.uk.
B W E M
BW
Powell
Department of Surgery, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands. Electronic address: j.vd.hage@nki.nl.
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JA
van der Hage
Department of Surgical Oncology, Vrije Universiteit Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. Electronic address: pam.vleeuwen@vumc.nl.
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PA
van Leeuwen
Department of Dermatology, Charité, University of Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany.
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CA
Voit
Division of Dermato Oncological Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. Electronic address: alessandro.testori@ieo.it.
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A
Testori
Department of Dermatology, Cancer Institute Gustave Roussy, 114 rue Édouard-Vaillant, 94805 Villejuif, France. Electronic address: caroline.robert@igr.fr.
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C
Robert
Department of Surgical Oncology, Groningen University, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands. Electronic address: h.j.hoekstra@umcg.nl.
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HJ
Hoekstra
Department of Surgical Oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands. Electronic address: d.grunhagen@erasmusmc.nl.
D J
DJ
Grünhagen
Cancer Institute Gustave Roussy, 114 rue Édouard-Vaillant, 94805 Villejuif, France. Electronic address: alexander.eggermont@igr.fr.
A M M
AM
Eggermont
Department of Surgery, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands. Electronic address: a.v.akkooi@nki.nl.
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AC
van Akkooi
D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D000071036:Sentinel Lymph Node / Q000473:pathology*; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors; D047368:Tumor Burden; D014850:Waiting Lists
Cutaneous melanoma; Melanoma; Melanoma specific survival; Prognosis; Sentinel lymph node biopsy; Waiting list