Sentinel lymph node biopsy versus observation in thick melanoma: A multicenter propensity score matching study

Abstract

The clinical value of sentinel lymph node (SLN) biopsy in thick melanoma patients (Breslow >4 mm) has not been sufficiently studied. The aim of the study is to evaluate whether SLN biopsy increases survival in patients with thick cutaneous melanoma, and, as a secondary objective, to investigate correlations between survival and lymph node status. We included 1,211 consecutive patients with thick melanomas (>4 mm) registered in the participating hospitals' melanoma databases between 1997 and 2015. Median follow-up was 40 months. Of these patients, 752 were matched into pairs by propensity scores based on sex, age, tumor location, histologic features of melanoma, year of diagnosis, hospital and adjuvant interferon therapy. The SLN biopsy vs. observation was associated with better DFS [adjusted hazard ratio (AHR), 0.74; 95% confidence interval (CI) 0.61-0.90); p = 0.002] and OS (AHR, 0.75; 95% CI, 0.60-0.94; p = 0.013) but not MSS (AHR, 0.84; 95% CI, 0.65-1.08; p = 0.165). SLN-negative patients had better 5- and 10-year MSS compared with SLN-positive patients (65.4 vs. 51.9% and 48.3 vs. 38.8%; p = 0.01, respectively). As a conclusion, SLN biopsy was associated with better DFS but not MSS in thick melanoma patients after adjustment for classic prognostic factors. SLN biopsy is useful for stratifying these patients into different prognostic groups.

Factors associated with sentinel lymph node status and prognostic role of completion lymph node dissection for thick melanoma

“…Keywords: melanoma, sentinel lymph node biopsy, complete lymph node dissection, prognosis Nevertheless, several studies have shown that SLN biopsy is useful in the prognostic stratification of patients with thick melanoma [2]. This, together with its value when selecting patients for new adjuvant treatments [3,4] means the procedure is still valid.…”

Age as a prognostic factor in thick and ultrathick melanomas without lymph node metastasis

“…The presence of regional metastasis is a predictor of worse survival in thick melanoma 1 and is currently an indication for adjuvant therapy. Few studies have analysed the prognostic role of clinical and pathologic variables in thick melanoma without metastatic lymph node involvement.…”

“…Editor, Frontal fibrosing alopecia (FFA) is a primary cicatricial alopecia characterized by a progressive recession of the frontotemporal hairline with frequent involvement of eyebrows. 1 FFA is more frequent in postmenopausal women, but it is increasingly diagnosed among premenopausal women and men. 2 Hair involvement is also common in other sites like eyelashes, extremities and axillae.…”

“…2 Hair involvement is also common in other sites like eyelashes, extremities and axillae. 1 FFA in males frequently presents as a slight-tomoderate recession of frontotemporal hairline that could be confused with mild androgenetic alopecia. 2,3 We present the case of a 52-year-old male who presented to our department with asymptomatic slow and progressive hair loss on the scalp, beard, eyebrows and body, for 5 years.…”

Trends and Outcomes of Sentinel Lymph Node Biopsy in Early-stage Vulvar Squamous Cell Carcinoma: A Population-based Study

“…Systemic inguinofemoral lymphadenectomy is considered a standard surgical procedure for vulvar SCC patients with >1 mm depth of invasion. Currently, lymphatic mapping and subsequent sentinel lymph node biopsy (SLNB) is the standard procedure in early-stage breast cancer and melanoma 8 , 9 . The incidence of inguinofemoral lymph node involvement for early-stage invasive vulvar SCC with clinically node negative is less than 30%; therefore, inguinofemoral lymphadenectomy could be omitted in about 70% of those patients, making SLNB an acceptable method in the management of early-stage vulvar SCC with negative groin nodes 10 - 12 .…”