title: The Prognostic Significance of Sentinel Lymph Node Status for Patients with Thick Melanoma.
abstract: Sentinel lymph node biopsy (SLNB) is recommended for patients with intermediate-thickness melanoma, but the use of SLNB for patients with thick melanoma is debated. This report presents a single-institution study investigating factors predictive of sentinel lymph node (SLN) metastasis and outcome for thick-melanoma patients .
  
  
  
  A retrospective review of a single-institution database from 1997 to 2012 identified 147 patients with thick primary cutaneous melanoma (≥4 mm) who had an SLNB. Clinicopathologic characteristics were correlated with nodal status and outcome.
  
  
  
  The median age of the patients was 67 years, and 61.9 % of the patients were men. The median tumor thickness was 5.5 mm, and 54 patients (36.7 %) had a positive SLN. Multivariable analysis showed that only tumor thickness significantly predicted SLN metastasis (odds ratio 1.14; 95 % confidence interval (CI) 1.02-1.28; P = 0.02). The overall median follow-up period was 34.6 months. Overall survival (OS) and melanoma-specific survival (MSS) were significantly worse for the positive versus negative-SLN patients. Multivariable analysis showed that age [hazard ratio (HR) 1.04; 95 % CI 1.01-1.07; P = 0.02] and SLN status (HR 2.24; 95 % CI 1.03-4.88; P = 0.04) significantly predicted OS, whereas only SLN status (HR 3.85; 95 % CI 2.13-6.97; P < 0.01) significantly predicted MSS.
  
  
  
  Tumor thickness predicts SLN status in thick melanomas. Furthermore, SLN status is prognostic for OS and MSS in thick-melanoma patients, with positive-SLN patients having significantly worse OS and MSS. These findings show that SLNB should be recommended for thick-melanoma patients, particularly because detection of SLN metastasis can identify patients for potential systemic therapy and treatment of nodal disease at a microscopic stage.
authors.affiliation: Section of Surgical Oncology, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Bello
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX, USA.
authors.forename: Gang
authors.initials: G
authors.lastname: Han
authors.affiliation: Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Jackson
authors.affiliation: Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Kaleigh
authors.initials: K
authors.lastname: Bulloch
authors.affiliation: Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Stephan
authors.initials: S
authors.lastname: Ariyan
authors.affiliation: Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Deepak
authors.initials: D
authors.lastname: Narayan
authors.affiliation: Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Bonnie Gould
authors.initials: BG
authors.lastname: Rothberg
authors.affiliation: Section of Surgical Oncology, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA. dale.han@yale.edu.
authors.forename: Dale
authors.initials: D
authors.lastname: Han
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008545:Melanoma / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D000071036:Sentinel Lymph Node / Q000473:pathology* / Q000601:surgery; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate; D047368:Tumor Burden