Sentinel node biopsy (SNB) in malignant melanoma as same day procedure vs delayed procedure: clinical and economic outcome

Abstract

The aim of this study was to compare a delayed sentinel node biopsy (dSNB) procedure with a same-day procedure (sSNB) in malignant melanoma. In March 2012, Aarhus University Hospital went from the dSNB to the sSNB procedure defined by lymphoscintigraphy (LS) and sentinel node biopsy (SNB) performed on the same day. Before that time, LS was performed 24 hours prior to SNB. The aim was to investigate whether differences between the two procedures exist. Patients who underwent the SNB procedure between April and July 2011 and 2012, respectively, were included in the study. The criteria for SNB were malignant melanoma thickness >1 mm, Clark level IV/V, and ulcus or unknown thickness of the melanoma. All patients underwent re-excision and SNB at the same time. Pathological evaluation was not changed in the observation periods; however, the LS procedures varied. Only a minor turnover among the surgeons was observed. One hundred and eight patients were included in the study, 59 (dSNB) from 2011 and 49 (sSNB) from 2012, respectively. A median of 2.17 (dSNB) and 2.31 (sSNB) SLNs were removed, with no statistical differences. No difference in node positivity rates was observed. However, the number of hospitalisation days differed significantly, with 1.94 days in dSNB and 0.49 days in sSNB. Rates of complications at the site of the SNB procedure were similar. No differences in disease-free survival (DFS) or overall survival (OS) were recorded. SNB does not increase the overall survival. It is, therefore, essential to keep the morbidity and economic costs low, while keeping the quality of the procedure high.

Utility of sentinel node biopsy in patients with high-risk cutaneous squamous cell carcinoma

“…5,7 Nodal metastases from cSCC, although rare and reported rates range from 0.3% to 16%, 8,9 are more common than distant metastasis. 9 Patients with nodal involvement require further surgery and/ or radiotherapy, and both risk of recurrence and mortality is affected adversely.…”

“…12 For the patient, complications are few and include anaphylactic reactions to blue dye, lymphedema, wound dehiscence, infection, hematoma and seroma. 7,11 This is well established in the staging of melanoma, but is still debated in the staging of cSCC though there are many studies suggesting that it has high sensitivity and NPV. 1,13 Selected lymph node dissection for patients with cSCC remains unproven.…”

Effect of delay between nuclear medicine scanning and sentinel node biopsy on outcome in patients with cutaneous melanoma

“…The Norwich centre recently published concerns about delaying SLNB beyond 12 h after LS using 99m Tc‐labelled nanocolloid in terms of patient outcomes, and attributed these concerns to temporal migration of the tracer to non‐SNs. It was acknowledged that the findings were controversial, and not consistent with other studies from North America and Australia. A potential weakness of the study was that the data came from a single institution and may not be representative of the outcomes of practice elsewhere.…”

“…Earlier reports investigated the feasibility of delaying SLNB for between 18 and 24 h after injections for breast cancer and melanoma, and concluded it to be safe and acceptable. These studies were mostly conducted in North America.…”

Primary Cutaneous Melanoma—Management in 2024

“…However, in the BAUSSS era, SLNB has a markedly limited role, with most patients having no indication for SLNB. Further, SLNB can be effectively undertaken at a later stage than the definitive excision when considered valuable for a specific patient [ 45 , 46 ].…”