Trends in Sentinel Lymph Node Biopsy Enactment for Cutaneous Melanoma

Abstract

Background Over recent years, sentinel lymph node biopsy (SLNB) recommendations in guidelines for cutaneous melanoma have changed considerably. We aimed to assess trends in enactment of SLNB to evaluate to what extent guidelines were adhered to, and to identify clinical and pathological determinants of (non-)adherence. Methods Clinicopathological data from the Dutch nationwide network and registry of histopathology and cytopathology were retrieved from patients diagnosed with primary cutaneous melanoma in The Netherlands between 2003 and 2014. SLNB enactment was analyzed per year. Multivariable regression models were developed to assess the determinants of SLNB enactment. Results A total of 51,510 primary cutaneous melanomas in 49,514 patients were diagnosed, of which 24,603 melanomas were eligible for SLNB as they were staged T1b or higher. In practice, only 9761 (39.7%) patients underwent SLNB, with an increasing trend from 39.1% in 2003 to 47.8% in 2014 ( p < 0.001). A total of 759 (2.9%) of 26,426 patients without SLNB indication underwent SLNB anyway. Variables significantly associated with enactment of SLNB were male sex, younger age, and melanoma on sites other than the head and neck. Conclusions Although there was an increasing trend in time in SLNB enactment, enactment of SLNB did not comply well with recommendations in (inter)national guidelines. Female sex, higher age, and melanoma located on the head and neck were associated with non-enactment of SLNB.

Management of the positive sentinel lymph node in the post‐MSLT‐II era

“…A recent study in the Netherlands found that for rates of sentinel node biopsy, head and neck melanoma was the only outlier. 18 In this study, patients with head and neck primaries actually received substantially fewer sentinel node biopsies compared with those with primaries in the trunk or extremities. This difference has not been previously explored and could be the focus of future investigation.…”

ASO Author Reflections: Sentinel Lymph Node Biopsy Trend in Melanoma: The More the Merrier

“…Although the trend showed an increase in SLNB enactment, from 39.1% in 2003, still only 47.8% of all eligible patients in 2014 underwent SLNB. Variables significantly associated with non-enactment were female gender, older age, and melanoma located on the head and neck 4…”

Значение Биопсии Сигнального Лимфатического Узла В Ведении Пациентов С Меланомой

“…Приблизно у 7 % пацієнтів діагностується III стадія захворювання, 5-річне виживання у них становить 60,8 %. У 18-25 % таких хворих виникають регіонарні рецидиви захворювання, асоційовані зі значним зниженням показників виживання [7,8]. При цьому регіонарні рецидиви є найчастішим першим проявом прогресування захворювання для пацієнтів із ІІІ стадією і становлять половину всіх випадків рецидивів хвороби [9,10].…”