Better-Defined Morbidity of Sentinel Lymph Node Biopsy in Patients with Melanoma

Sentinel lymph node biopsy (SLNB) is crucial for staging malignant melanoma, but introduces additional risks and costs. This study aims to evaluate the quality and morbidity of SLNB at our institution.

We conducted a retrospective analysis of patients who underwent SLNB between 2017 and 2024. Patients were included if they underwent surgical treatment for melanoma and were evaluated for SLNB. Quality metrics included percentage of clinical stage Ib/II disease undergoing SLNB, node identification rate, and pathologic positivity rate. Morbidity was assessed, and the burden of care was determined by number of postoperative clinic visits.

In total, 153 patients underwent SLNB with a mean age of 65 (30-96) years and a male:female ratio of 55:45. A sentinel node was identified in 150 patients (98.0%) with a mean of 1.89 nodes excised and metastases identified in 22 patients (14.7%). Complications occurred in 22 patients (14.4%), including seroma drainage (n = 15, 9.8%), wound infection (n = 5, 3.3%), hematoma (n = 3, 1.8%), and lymphedema (n = 4, 2.4%). Patients with SLN complications had more postoperative visits than those without complications (mean 2.38 versus 1.66, p = 0.0004). Patients undergoing SLNB with wide local excision (WLE) had more visits compared with WLE alone (mean 1.84 versus 1.23, p < 0.0001).

SLNB is valuable for melanoma staging, with reliable identification and detection of metastases, but is associated with additional morbidity, which increases the burden of care. These findings may add value in deciding the merits of SLNB in patients with a lower risk of SLN metastases.