Sentinel Lymph Node Biopsy in Patients with Thick Primary Cutaneous Melanoma: Patterns of Use and Underuse Utilizing a Population-Based Model

Abstract

Background. Sentinel lymph node biopsy (SLNB) for thick cutaneous melanoma is supported by national guidelines. We report on factors associated with the use and underuse of SLNB for thick primary cutaneous melanoma. Methods. The Surveillance, Epidemiology, and End Results database was queried for patients who underwent surgery for thick primary cutaneous melanoma from 2004 to 2008. We used multivariate logistic regression models to predict use of SLNB. Results. Among 1,981 patients, 833 (41.8%) did not undergo SLNB. Patients with primary melanomas of the arm (OR 2.07, CI 1.56–2.75; P < 0.001), leg (OR 2.40, CI 1.70–3.40; P < 0.001), and trunk (OR 1.82, CI 1.38–2.40; P < 0.001) had an increased likelihood of receiving a SLNB, as did those with desmoplastic histology (OR 1.47, CI 1.11–1.96; P = 0.008). A decreased likelihood of receiving SLNB was noted for advancing age ≥ 60 years (age 60 to 69: OR 0.58, CI 0.33–0.99, P = 0.047; age 70 to 79: OR 0.32, CI 0.19–0.54, P < 0.001; age 80 or more: OR 0.10, CI 0.06–0.16, P < 0.001) and unknown race/ethnicity (OR 0.21, CI 0.07–0.62; P = 0.005). Conclusions. In particular, elderly patients are less likely to receive SLNB. Further research is needed to assess whether use of SLNB in this population is detrimental or beneficial.

Prognostic value of sentinel lymph node biopsy in melanomas of different Breslow’s thickness

“…Despite the fact that SLNB for lymph node staging of thick primary cutaneous melanomas has been recommended by various guideline and studies [17,29,[44][45][46][47][48], its beneficial effects are still controversial [11,26,44]. Opponents state that the procedure is useless in the patients with thick melanoma because it does not provide significant prognostic information, and outcome will be changed by occult metastasis and not SLNB status [10,26,44,49,50]. These statements have been supported by studies showing no benefit in overall survival according to the SLNB result [10,11,51].…”