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Evaluating Variation in Lymph Node Sampling During Sentinel Lymph Node Biopsy for Melanoma.

Crystal D Taylor1,2,3,4, Vanessa S Niba1,2,3,4, Alison S Baskin5

  • 1Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA.

Annals of Surgical Oncology
|August 16, 2025
PubMed
Summary
This summary is machine-generated.

Sentinel lymph node biopsy (SLNB) for melanoma shows minimal variation in nodal yield and positivity across facilities. This suggests current practices are standardized, with future improvements potentially focusing on other surgical techniques.

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Cancer Staging

Background:

  • The Commission on Cancer (CoC) operative standard for melanoma lacks SLNB data, unlike breast cancer standards.
  • Sentinel lymph node biopsy (SLNB) is crucial for melanoma nodal staging.
  • This study assessed facility-level variation in nodal yield and positivity for melanoma SLNB.

Purpose of the Study:

  • To characterize facility-level variation in nodal yield for melanoma SLNB.
  • To determine variation in nodal positivity for melanoma SLNB.
  • To identify opportunities for standardization in melanoma SLNB.

Main Methods:

  • Analysis of National Cancer Database (2018-2022) for melanoma patients (T1b-T4) of the trunk and upper extremities undergoing SLNB.
  • Reliability-adjusted estimates for nodal yield and positivity calculated.
  • Poisson and logistic regression with random intercepts used for hospital-level analysis.

Main Results:

  • 48,653 melanoma patients from 1167 facilities were analyzed.
  • Median nodal yield was 2.4 (IQR 2.2-2.7), with facility range 1.4-7.0.
  • Median nodal positivity was 18.0% (IQR 17.1-19.5%), with facility range 11.6-40.5%.

Conclusions:

  • Facility-level variation in melanoma SLNB nodal yield was minimal and weakly correlated with nodal positivity.
  • Melanoma SLNB appears well-standardized across CoC hospitals without a specific operative standard.
  • Future quality improvement efforts may target lymphadenectomy or novel dissection approaches.