Improving Risk Stratification for SLNB in Elderly Patients With Melanoma: The SENTINOLD Nomogram.
Nieves Martínez Campayo1, Sabela Paradela de la Morena1, Sebastian Podlipnik2
1Dermatology Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
International Journal of Dermatology
|April 12, 2026
Summary
A new SENTINOLD nomogram accurately predicts sentinel lymph node positivity in elderly melanoma patients (≥75 years). This tool aids clinical decisions regarding sentinel lymph node biopsy (SLNB) in older adults.
Area of Science:
- Oncology
- Dermatology
- Biostatistics
Background:
- Sentinel lymph node biopsy (SLNB) is crucial for melanoma prognosis but controversial in elderly patients due to risks and lower benefit.
- Elderly patients (≥75 years) with cutaneous melanoma present unique challenges for SLNB decision-making.
Purpose of the Study:
- To develop and validate a predictive model for sentinel lymph node positivity specifically for elderly melanoma patients (≥75 years).
- To compare the performance of the new model against existing calculators (MIA and MSKCC).
Main Methods:
- A retrospective cohort study (SENTINOLD) of 795 elderly melanoma patients across seven Spanish hospitals.
- Development of a multivariable logistic regression model using 12 clinicopathologic variables.
- Performance assessment included discrimination (AUC), calibration, decision curve analysis (DCA), and temporal validation.
Main Results:
- The SENTINOLD nomogram showed superior discrimination (AUC=0.71) compared to MSKCC (0.66) and MIA (0.64) calculators.
- The model demonstrated good calibration and clinical utility within the 5%-20% decision threshold.
- Temporally validated performance remained stable (AUC=0.68).
Conclusions:
- The SENTINOLD nomogram is a reliable tool for predicting sentinel lymph node positivity in elderly melanoma patients.
- It supports individualized SLNB decision-making in this population.
- Further external validation and prospective studies are recommended.
