Is sentinel lymph node biopsy needed for lentigo maligna melanoma?

Area of Science:

• Dermatology
• Surgical Oncology
• Oncology

Background:

• Sentinel lymph node biopsy (SLNB) is debated in lentigo maligna melanoma (LMM) management.
• The prognostic utility of SLNB in LMM has not been extensively studied using large datasets.

Purpose of the Study:

• To evaluate the utility and prognostic value of SLNB in cutaneous nonmetastatic LMM with Breslow thickness >1.0 mm.
• To identify factors associated with SLNB performance and sentinel lymph node (SLN) positivity.
• To assess the impact of SLNB on overall survival (OS) and melanoma-specific survival (MSS).

Main Methods:

• Retrospective review of the National Cancer Database (2012-2020) and Surveillance, Epidemiology, and End Results (2010-2019) databases.
• Multivariable logistic regression to identify predictors of SLNB performance and SLN positivity.
• Univariable and multivariable analyses to assess OS and MSS based on SLNB and SLN status.

Main Results:

• LMM exhibited lower SLNB rates (66.6%) and SLN positivity (11.3%) compared to other melanoma subtypes.
• SLN status was significantly associated with improved OS for both SLN-positive and SLN-negative patients.
• Positive SLN status was associated with worse MSS (HR=3.93, p<0.05).

Conclusions:

• Improved OS with SLNB suggests potential surgical selection bias.
• Melanoma-specific survival analysis supports patient selection and indicates prognostic value of SLN status.
• These findings advocate for the continued use of SLNB in LMM management per standard guidelines.