The Influence of Sentinel Lymph Node Biopsy on Survival for Intermediate-Thickness Melanoma

Abstract

Status of the sentinel node is the strongest predictor of survival in patients with intermediate thickness melanoma. SNB compared with observation was associated with a modest survival advantage.

Sentinel lymph node biopsy is prognostic but not therapeutic for thick melanoma

“…For patients with intermediate thickness melanoma, the MSLT-1 trial and other literature suggest strongly a small but clinically meaningful survival advantage. [13][14][15] Although at 10 years the DSS from the MSLT-1 failed demonstrate a survival advantage for SNB, the investigators postulated that the failure to document a survival advantage was secondary to a dilution effect of node-negative patients, and as such, the trial was underpowered to potentially identify an improvement in survival for the 20% of patients with nodal disease. 14 Retrospective large database studies with sufficient statistical power have been able to demonstrate a modest survival advantage to SNB for intermediate thickness melanoma.…”

“…14 Retrospective large database studies with sufficient statistical power have been able to demonstrate a modest survival advantage to SNB for intermediate thickness melanoma. 13,16 Few data are available about the therapeutic value of SNB in thick melanoma. Most of the studies reporting survival have been small, single institutional, and retrospective and failed to demonstrate a survival advantage.…”

“…Patients with a negative SNB have a 5-year survival of 84-96.8% compared with 40-72.3% with a positive SNB. [10][11][12][13] In the only prospective, randomized clinical trial examining SNB versus observation (no SNB), the MSLT-1 trial, Morton et al 14 found that the status of the SNB in patients with melanoma between 1.2-3.5 mm was the strongest predictor of survival.…”

“…Consistent with the finding of the MSLT-1 trial, our group found that patients with intermediate thickness melanoma undergoing SNB had a modest but significant survival advantage when compared with observation. 13 As a result of conflicting data on the prognostic and therapeutic values of SNB for thick melanoma (>4 mm), the clinical utility in this group is less clear. Several studies and a Bayesian analysis reported no prognostic value to SNB for thick melanoma.…”

Stratifying SLN incidence in intermediate thickness melanoma patients

“…5 SLNB has been found to have prognostic value and it has been shown to offer a survival benefit over observation alone. 2,6,7 …”