Effects of time interval between primary melanoma excision and sentinel node biopsy on positivity rate and survival.
Sentinel node biopsy (SNB) is essential for adequate melanoma staging. Most melanoma guidelines advocate to perform wide local excision and SNB as soon as possible, causing time pressure.



To investigate the role of time interval between melanoma diagnosis and SNB on sentinel node (SN) positivity and survival.



This is a retrospective observational study concerning a cohort of melanoma patients from four European Organization for Research and Treatment of Cancer Melanoma Group tertiary referral centres from 1997 to 2013. A total of 4124 melanoma patients underwent SNB. Patients were selected if date of diagnosis and follow-up (FU) information were available, and SNB was performed in <180 d. A total of 3546 patients were included. Multivariable logistic regression and Cox regression analyses were performed to investigate how baseline characteristics and time interval until SNB are related to positivity rate, disease-free survival (DFS) and melanoma-specific survival (MSS).



Median time interval was 43 d (interquartile range [IQR] 29-60 d), and 705 (19.9%) of 3546 patients had a positive SN. Sentinel node positivity was equal for early surgery (≤43 d) versus late surgery (>43 d): 19.7% versus 20.1% (p = 0.771). Median FU was 50 months (IQR 24-84 months). Sentinel node metastasis (hazard ratio [HR] 3.17, 95% confidence interval [95% CI] 2.53-3.97), ulceration (HR 1.99, 95% CI 1.58-2.51), Breslow thickness (HR 1.06, 95% CI 1.04-1.08), and male gender (HR 1.58, 95% CI 1.26-1.98) (all p < 0.00001) were independently associated with worse MSS and DFS; time interval was not.



No effect of time interval between melanoma diagnosis and SNB on 5-year survival or SN positivity rate was found for a time interval of up to 3 months. This information can be used to counsel patients and remove strict time limits from melanoma guidelines.
Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands. Electronic address: c.oudeophuis@erasmusmc.nl.
Charlotte M C
CM
Oude Ophuis
Department of Surgical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, The Netherlands. Electronic address: a.v.akkooi@nki.nl.
Alexander C J
AC
van Akkooi
Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland. Electronic address: rutkowskip@coi.waw.pl.
Piotr
P
Rutkowski
Department of Dermatology, Venerology and Allergology, Charité - University, Medicine Berlin, Berlin, Germany.
Christiane A
CA
Voit
Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland. Electronic address: jostepniak@gmail.com.
Joanna
J
Stepniak
Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands. Electronic address: n.erler@erasmusmc.nl.
Nicole S
NS
Erler
Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands; General Director, Department of Surgical Oncology, Gustave Roussy Cancer Campus Grand Paris, Villejuif/Paris-Sud, France. Electronic address: alexander.eggermont@gustaveroussy.fr.
Alexander M M
AM
Eggermont
Department of Surgical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, The Netherlands. Electronic address: m.wouters@nki.nl.
Michel W J M
MW
Wouters
Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands. Electronic address: d.grunhagen@erasmusmc.nl.
Dirk J
DJ
Grünhagen
Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands. Electronic address: c.verhoef@erasmusmc.nl.
Cornelis Kees
CK
Verhoef
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D062109:Dermatologic Surgical Procedures / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors
Melanoma; Prognosis; Sentinel lymph node biopsy; Sentinel node; Survival; Timing of surgery; Wait list