Role of sentinel lymph node biopsy for cutaneous melanoma in elderly patients: preliminary results in a Latin-American population

Abstract

Introduction:In melanoma, lymph node status constitutes the most important prognostic factor among patients with locoregional disease. It has been postulated that elderly patients present less metastatic involvement in sentinel lymph node (SLN). Our objective was to analyse the results and evolution of patients ≥ 70 years-old with cutaneous melanoma in whom sentinel lymph node biopsy (SLNB) was carried out.Methods: Retrospective analysis of 194 patients with primary CM who had a SLNB between 2005 and 2020 was included. Demographic and tumour data, SLN status, recurrence rate, morbidity and evolution were evaluated. Patients were divided into two groups according to age: Group 1 (<70 years old) and Group 2 (≥70 years old).Results: One hundred and fifty patients were included in Group 1 and 44 patients in Group 2. Median Breslow thickness was 1.7 mm in Group 1 and of 2 mm in Group 2 (p = 0.015).Forty-seven patients had positive SLNB; 38 (25%) belonged to Group 1 and 9 (20.5%) to Group 2 (p = 0.55). Recurrence was found in 34 patients: 25 belonging to Group 1 and 9 corresponding to Group 2 (p = 0.65). Morbidity was of 4% in Group 1 and 9% in Group 2 (p = 0.23). With an average follow-up of 30.6 months, 5-year overall survival was of 87% in Group 1 and of 63% in Group 2 (p = 0.04). Conclusion:Advanced age was not associated with differences regarding positivity of SLN and recurrence but difference in overall survival was observed. According to our results and the low morbidity rate, we consider SLNB should not be omitted in such age group, since it improves staging and gives the possibility to evaluate adjuvant treatment.

Sentinel lymph node biopsy for melanoma in the older population: A prospective analysis of outcomes

“…31 SLNB success and positivity rates were reported by all the papers, however, only two studies had a suitable control for comparisons to a younger population. 28,30 Histology reports were provided by two of the papers, who also documented a higher Breslow thickness in their elderly groups similar to our results. 8,17 Only one study reported on the incidence of seroma, 31 with no papers providing a thorough complication profile for SLNB in the older population.…”

“…All but one study was retrospective in nature 31 . SLNB success and positivity rates were reported by all the papers, however, only two studies had a suitable control for comparisons to a younger population 28,30 . Histology reports were provided by two of the papers, who also documented a higher Breslow thickness in their elderly groups similar to our results 8,17 .…”

“…27 From the wider literature, six articles were found focussing on SLNB in the older population. 8,17,[28][29][30] These studies reported results from a range of 44 to 423 elderly patients, however two studies used an age cut-off of 65 years old. 29,30 All but one study was retrospective in nature.…”

Primary Melanoma Histopathologic Predictors of Sentinel Lymph Node Positivity: A Proposed Scoring System for Risk Assessment and Patient Selection in a Clinical Setting

“…Age has been discussed by many authors, with the study results implying that being young increases both the SLNB positivity rates as well as the survival rates, whereas elderly patients are less likely to be SLNB-positive, but have a worse prognosis [32,33]. Other single-center studies report higher SLNB positivity rates in senior patients as well as higher SLNB surgical complication rates, while some authors express the benefits of SLNB in senior population with regard to staging and exploring the possibilities of adjuvant therapy [3,34]. Thus, certain clinical scenarios could still be considered a grey area in SLNB decision making.…”