Increase of Sentinel Lymph Node Melanoma Staging in The Netherlands; Still Room and need for Further Improvement

Abstract

Aim: To investigate implementation of the seventh American Joint Committee on Cancer melanoma staging with sentinel lymph node biopsy (SLNB) and associations with socioeconomic status (SES). Patients & methods: Data from The Netherlands Cancer Registry on patient and tumor characteristics were analyzed for all stage IB–II melanoma cases diagnosed 2010–2016, along with SES data from The Netherlands Institute for Social Research. Results: The proportion of SLNB-staged patients increased from 40% to 65% (p < 0.001). Multivariate analysis showed that being female, elderly, or having head-and-neck disease reduced the likelihood of SLNB staging. Conclusion: SLNB staging increased by 25% during the study period but lagged among elderly patients and those with head-and-neck melanoma. In The Netherlands, SES no longer affects SLNB staging performance.

Obesity is not associated with disease‐free interval, melanoma‐specific survival, or overall survival in patients with clinical stage IB‐II melanoma after SLNB

“…This suggests that the medical treatment and financial resources of patients with early stage melanoma are independent of SES level in the Netherlands. 39 …”

Letter in Reply: Increase of Sentinel Lymph Node Melanoma Staging in the Netherlands; Still Room and Need for Further Improvement

“…It is important to note that very large regional differences were observed in The Netherlands, 74% SLNBs in the northeast of The Netherlands compared with 56% in the rest of The Netherlands (p < 0.01). It is remarkable to see that in 2015 and 2016 no further increase was seen in SLNB staging in the northeast of The Netherlands, in contrast to the rest of The Netherlands [3].…”

“…The proportion of sentinel lymph node biopsy (SLNB)-staged melanoma patients increased in The Netherlands, according to The Netherlands Cancer Registry, from 24% (2004) to 55% (2011) to 65% (2016) [1][2][3]. It is important to note that very large regional differences were observed in The Netherlands, 74% SLNBs in the northeast of The Netherlands compared with 56% in the rest of The Netherlands (p < 0.01).…”

Prediction in cutaneous melanomas

“…41 Later, in 2004, it was suggested to add an "E", for evolving. 42 Although the majority of people believe one should mainly be aware of pre-existing nevi, only 30% of melanomas are thought to arise from a pre-existing nevus. [43][44][45] The majority of melanomas thereby arise de novo.…”

“…In 2003 in the Netherlands, 40% of all eligible patients (n= 24,603) underwent SN biopsy 41 , which increased to still only 65% in 2016 42 , with significant variation per region. 43 Selecting only the most appropriate patients for early adjuvant systemic therapy is of great importance.…”