Sentinel lymph node biopsy for cutaneous melanoma: A 6 years study

ABSTRACT

Background: The aim of this study was to evaluate the results of sentinel lymph node biopsy (SLNB) in cutaneous melanoma at our institution. Materials and Methods: 128 patients with primary cutaneous melanoma who underwent SLNB between April, 2004, and August, 2010 were studied. Univariate and multivariate analysis was performed to explore the effect of variables on mortality and sentinel node status. Survival analysis was performed using the Kaplan-Meier approach. Results: Positive SLNB were detected in 35 (27.3%) of 128 cases. Mean Breslow depths were 3.7 mm for SLNB positive patients and 1.99 mm for SLNB negative patients. False negative rate was 1%. The recurrence rate was 40% for positive patients and 6.5% for negative patients (odds ratio 9.7 [confidence interval 95 % 3.3-28.1]). 33 patients (29%) had an ulcerated melanoma, 12 (10.5%) in the positive group and 21 (18.5%) in the negative group. The disease recurred in a 48.5% of patients with ulcerated melanoma, but only in a 2.5% of patients with non-ulcerated melanoma. Upon multivariate analysis, only Breslow thickness (P = 0.005) demonstrate statistically significance for SLNB status. Multivariate analysis for clinicopathologic predictors of death demonstrate statistically significance for Breslow thickness (P = 0.020), ulceration (P = 0.030) and sentinel node status (P = 0.020). Conclusions: This study confirms that the status of the sentinel node is a strong independent prognostic factor with a higher risk of death and lower survival. Patients with ulcerated melanoma are more likely to develop recurrence, and also higher risk of death than patients with non-ulcerated melanoma.

KEY WORDS

Melanoma - sentinel node biopsy - sentinel node dissection

• 1 Surveillance Epidemiology and End Results. Available from: http://seer.cancer.gov/statfacts/html/melan.html#ref11. [Accessed 2011 Jul 28].
• 2 Fleming ID, Cooper JS, Henson DE, Hutter RVP, Kennedy BJ, Murphy GP et al. AJCC Cancer Staging Manual. 5 th ed. Philadelphia: Lippincott-Raven; 1997.
• 3 Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992;127:392-9.
• 4 Ross MI. Sentinel node biopsy for melanoma: An update after two decades of experience. Semin Cutan Med Surg 2010;29:238-48.
• 5 Blaheta HJ, Ellwanger U, Schittek B, Sotlar K, MacZey E, Breuninger H, et al. Examination of regional lymph nodes by sentinel node biopsy and molecular analysis provides new staging facilities in primary cutaneous melanoma. J Invest Dermatol 2000;114:637-42.
• 6 Estourgie SH, Nieweg OE, Valdés Olmos RA, Hoefnagel CA, Kroon BB. Review and evaluation of sentinel node procedures in 250 melanoma patients with a median follow-up of 6 years. Ann Surg Oncol 2003;10:681-8.
• 7 Balch CM, Gershenwald JE, Soong SJ, Thompson JF, Atkins MB, Byrd DR, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol 2009;27:6199-206.
• 8 Cochran AJ, Ohsie SJ, Binder SW. Pathobiology of the sentinel node. Curr Opin Oncol 2008;20:190-5.
• 9 Cascinelli N, Belli F, Santinami M, Fait V, Testori A, Ruka W, et al. Sentinel lymph node biopsy in cutaneous melanoma: The WHO melanoma program experience. Ann Surg Oncol 2000;7:469-74.
• 10 Morton DL, Thompson JF, Essner R, Elashoff R, Stern SL, Nieweg OE, et al. Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: A multicenter trial. Multicenter selective lymphadenectomy trial group. Ann Surg 1999;230:453-63.
• 11 Brobeil A, Cruse CW, Messina JL, Glass LF, Haddad FF, Berman CG, et al. Cost analysis of sentinel lymph node biopsy as an alternative to elective lymph node dissection in patients with malignant melanoma. Surg Oncol Clin N Am 1999;8:435-45, viii.
• 12 McMasters KM, Swetter SM. Current management of melanoma: Benefits of surgical staging and adjuvant therapy. J Surg Oncol 2003;82:209-16.
• 13 Medalie N, Ackerman AB. Sentinel node biopsy has no benefit for patients whose primary cutaneous melanoma has metastasized to a lymph node and therefore should be abandoned now. Br J Dermatol 2004;151:298-307.
• 14 Möhrle M, Schippert W, Rassner G, Garbe C, Breuninger H. Is sentinel lymph node biopsy of therapeutic relevance for melanoma? Dermatology 2004;209:5-13.
• 15 Gutzmer R, Al Ghazal M, Geerlings H, Kapp A. Sentinel node biopsy in melanoma delays recurrence but does not change melanoma-related survival: A retrospective analysis of 673 patients. Br J Dermatol 2005;153:1137-41.
• 16 Stebbins WG, Garibyan L, Sober AJ. Sentinel lymph node biopsy and melanoma: 2010 update Part I. J Am Acad Dermatol 2010;62:723-34.
• 17 Eigentler TK, Buettner PG, Leiter U, Garbe C, Central Malignant Melanoma Registry of the German Dermatological Society. Impact of ulceration in stages I to III cutaneous melanoma as staged by the American joint committee on cancer staging system: An analysis of the German central malignant melanoma registry. J Clin Oncol 2004;22:4376-83.
• 18 Stebbins WG, Garibyan L, Sober AJ. Sentinel lymph node biopsy and melanoma: 2010 update Part II. J Am Acad Dermatol 2010;62:737-48.
• 19 Berk DR, Johnson DL, Uzieblo A, Kiernan M, Swetter SM. Sentinel lymph node biopsy for cutaneous melanoma: The Stanford experience, 1997-2004. Arch Dermatol 2005;141:1016-22.
• 20 Måsbäck A, Olsson H, Westerdahl J, Ingvar C, Jonsson N. Prognostic factors in invasive cutaneous malignant melanoma: A population-based study and review. Melanoma Res 2001;11:435-45.