Sentinel lymph node biopsy is indicated for patients with thick clinically lymph node-negative melanoma

Area of Science:

• Oncology
• Dermatology
• Surgical Pathology

Background:

• Sentinel lymph node biopsy (SLNB) is standard for intermediate-thickness melanoma but controversial for thick melanoma.
• Thick melanoma (≥4 mm) presents unique staging challenges.

Purpose of the Study:

• To evaluate the utility of SLNB in staging clinically lymph node-negative patients with thick melanoma.
• To assess the impact of SLNB status on survival outcomes in this patient group.

Main Methods:

• Retrospective analysis of 571 patients with melanoma ≥4 mm thickness from 2002-2012.
• Exploration of associations between survival and clinicopathologic characteristics, including SLNB status.

Main Results:

• Patients with negative SLNB showed significantly prolonged recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS) compared to those with positive SLNB or clinically positive nodes.
• The false-negative rate for SLNB in this cohort was 12.3%.
• Median DSS and OS were 82.4 and 53.4 months for negative SLNB, versus 41.2 and 34.7 months for positive SLNB.

Conclusions:

• SLNB in thick melanoma, despite a 12.3% false-negative rate, identifies patients with significantly better survival outcomes.
• SLNB should be considered for staging thick, clinically lymph node-negative melanoma due to its prognostic value.