Sentinel lymph node status is the most important prognostic factor for thick (> or = 4 mm) melanomas

Area of Science:

• Oncology
• Dermatology
• Surgical Pathology

Background:

• The prognostic value of sentinel lymph node (SLN) status in patients with thick melanomas (Breslow thickness ≥ 4 mm) remains debated.
• Accurate prognostic indicators are essential for guiding treatment decisions in melanoma management.

Purpose of the Study:

• To evaluate the prognostic significance of SLN status in patients diagnosed with thick primary melanomas.
• To compare the predictive value of SLN status against other clinicopathological factors.

Main Methods:

• A cohort of 152 patients with primary melanomas ≥ 4 mm thickness underwent sentinel lymph node excision (SLNE).
• Kaplan-Meier survival estimates and Cox regression models were employed for statistical analysis.
• Prognostic factors analyzed included SLN status, tumor thickness, ulceration, age, and sex.

Main Results:

• Micrometastasis to the SLN was detected in 48.7% of patients.
• Patients with positive SLNs were significantly younger than those with negative SLNs (p = 0.01).
• Five-year recurrence-free survival was 26.3% for positive SLN and 58.7% for negative SLN.
• Five-year overall survival was 37.5% for positive SLN and 67.6% for negative SLN.
• Multivariate analysis identified SLN status as a highly significant predictor of overall survival (p = 0.007).
• Nodal metastasis penetration into the SLN > 0.3 mm significantly impacted overall survival (p = 0.001).
• Tumor thickness and ulceration were not significant prognostic factors in this cohort.

Conclusions:

• Sentinel lymph node status is the paramount prognostic marker for patients with thick melanomas.
• The prognostic value of tumor thickness and ulceration is diminished when considering SLN status.
• SLN status provides critical information for predicting survival outcomes in high-risk melanoma patients.