Receipt of sentinel lymph node biopsy for thin melanoma is associated with distance traveled for care

Abstract

Background Sentinel lymph node biopsy (SLNB) is not routinely recommended for thin melanoma. However, it is considered when high‐risk features, clinicopathological, or sociodemographic, are present. It was our objective to evaluate the impact of travel distance on decision‐making for SLNB in thin melanoma. Methods We used the National Cancer DataBase (1998‐2011) to identified patients with thin melanoma (≤1 mm thickness). The primary exposure was distance traveled for care, categorized as short (<12.5 miles), intermediate (12.5‐49.9 miles), or long (≥50 miles). The primary outcome was receipt of SLNB. Results We identified 21 124 cases of thin melanoma; 48.8%, 38.2%, and 13.0% traveled short, intermediate, and long distances, respectively. Overall, SLNB was performed in 32.8% of patients. Traveling farther was associated with a step‐wise increase in the likelihood of undergoing a SLNB (P‐trend < 0.001). Even after adjusting for patient, disease, and facility factors, we found that patients who traveled an intermediate distance were 18% more likely to undergo a SLNB (OR:1.18; 95%CI: 1.10,1.27), and those who traveled a long distance were 24% more likely (OR:1.24; 95%CI: 1.11,1.39) compared with those who traveled a short distance. Conclusions The distance patients travel for surgical care appears to be an independent factor influencing the receipt of SLNB.

Sentinel lymph node biopsy guideline concordance in melanoma: Analysis of the National Cancer Database

“…Despite the utility of SLNB in certain patients with clinically node‐negative melanoma, there has been mixed adherence with national consensus guidelines 6–8 . Overutilization of SLNB may lead to unnecessary postoperative morbidity and increased medical expenditures 9 .…”

“…Underutilization may lead to the incomplete acquisition of prognostic and staging information 10–12 . Various patient and facility factors have been shown to be associated with SLNB adherence 6–8 . Additionally, facility type has also been implicated in the lack of guideline‐concordance among other cancers, but this has not been explored in melanoma 13–15 …”

A retrospective study of sentinel lymph node biopsy for skin cancer in Japan: Comparison with breast cancer and evaluation of factors related to its use

“…SLNB is performed more frequently in hospitals with more beds, which could be due to high‐volume hospitals serving as academic centers and having more medical staff to complete SLNB. Previous studies have reported higher compliance with SLNB guidelines in academic facilities 22,31,36,37 . The increased performance at academic centers is likely due to greater awareness of guidelines in this setting.…”

“…Previous studies have reported higher compliance with SLNB guidelines in academic facilities. 22 , 31 , 36 , 37 The increased performance at academic centers is likely due to greater awareness of guidelines in this setting.…”