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Sentinel node biopsy for thin melanomas: which patients should be considered?
Christopher A Puleo1, Jane L Messina, Adam I Riker
1Cutaneous Oncology Division, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA.
Cancer Control : Journal of the Moffitt Cancer Center
|November 1, 2005
Summary
Sentinel node biopsy is recommended for thin melanomas (0.75-1.00 mm) to detect nodal metastasis. Discuss risks and benefits, as survival benefits are unproven.
Area of Science:
- Oncology
- Dermatology
- Surgical Pathology
Background:
- Increasing incidence of melanoma, particularly thin melanomas.
- Limitations of current prognostic factors for predicting nodal metastasis.
- Need for improved methods to identify patients benefiting from early nodal staging.
Purpose of the Study:
- Evaluate sentinel node biopsy (SNB) in thin melanomas (<1.00 mm Breslow thickness).
- Assess Clark level as a predictor of positive SNB.
- Identify indicators for SNB in thin melanoma patients.
Main Methods:
- Retrospective review of 409 patients with thin melanomas.
- Analysis of SNB results and correlation with Clark level.
- Literature review for prognostic indicators in thin melanoma.
Main Results:
- Overall nodal progression incidence of 4.9% (20/409 patients).
- Clark level IV melanomas showed a higher rate of nodal metastasis compared to levels II/III.
- Micrometastases identified in 4.9% of patients.
Conclusions:
- Melanomas between 0.75-1.00 mm are candidates for SNB.
- Informed discussion should include nodal progression likelihood, SNB risks (false negatives), and lack of proven survival benefit.
- SNB can aid in staging thin melanomas.
