Thick Melanoma: Prognostic Value of Positive Sentinel Nodes

Abstract

To be accurately informed about a patient's prognosis and to decide whether subsequent completion lymph node dissection is indicated, SNB should not be omitted in patients with a primary thick melanoma.

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

“…18 In contrast, multiple studies have demonstrated that the status of the sentinel lymph node is predictive of survival with node-negative patients having a 5-year survival of 56-71% versus 26-48% with node-positive disease. [30][31][32][33][34] In a recent metaanalysis by Rondelli et al, 35 and colleagues SNB status was predictive of survival with a 71% 5-year survival if node(s) was negative for disease and 39% if positive. 35 Our findings are similar with a 5-year DSS of 75.4% for negative sentinel node patients versus 44.1 % in node-positive patients (Fig). In addition, as new immunotherapy regimens for melanoma are studied in the adjuvant setting, the status of SNB may provide important information for patient selection.…”

Prognostic Usefulness of Sentinel Lymph Node Biopsy for Patients Who Have Clinically Node Negative, Localized, Primary Invasive Cutaneous Melanoma

“…While clinically node-negative patients with 4-mm or thicker tumors have a 60% to 70% risk of regional micrometastatic disease and a 70% risk of occult systemic disease at the time of presentation, 48 multiple authors make a case for SLNB in this subgroup because SLNB status is a powerful predictor of overall survival by univariate and multivariate analysis. [48][49][50][51][52][53][54] For the single informative case series of patients with thick tumors reported by Essner et al, 21 in which the CM-related death rate for the cohort was 31.0%, risk of CM-related death was 32.5% for cases with a positive SLNB result and 30.1% for cases with a negative SLNB result, with a median follow-up of 31 months (range, 2-73 months) (eTable 1). In this report, tumor status of the SLNB was predictive of diseasefree survival but not overall survival.…”

Malignant melanoma in elderly patients: biological, surgical and medical issues

“…Age-related disparities in surgical management of primitive melanoma A significant proportion of patients with thick melanomas do not undergo lymph node staging with SLNB, despite the fact that it has been recommended by guidelines since 1998 and supported by retrospective and prospective institutional data [55][56][57][58][59][60][61][62][63][64][65] There are several possible explanations for this discrepancy. For example, multimorbidity could have precluded the use of SLNB in older patients.…”