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Sentinel Lymph Node Biopsy in T4 Melanoma: An Important Risk-Stratification Tool

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Sentinel lymph node biopsy (SLNB) is a sensitive test for detecting subclinical nodal metastatic disease in patients with melanoma without evidence of lymph node involvement. The prognostic significance of SLN positivity in patients with melanoma >4 mm thick (T4) is unclear. The survival curves in the current AJCC staging system suggest that the status of the SLN is not predictive of outcome for patients with T4 melanoma.

Methods

Patients with primary T4 melanoma without clinical nodal involvement who underwent SLNB between 2002 and 2012 at Peter MacCallum Cancer Centre were included in the analysis with chart review performed to collect clinical, pathological, and outcome data. A meta-analysis was performed including similar studies of SLNB in T4 melanoma, which reported overall survival (OS) data.

Results

Of 217 patients who underwent SLNB, 78 patients had a positive SLN (36 %). The 5-year OS for SLNB negative and positive patients was 68 and 45 %, respectively [hazard ratio (HR) 2.82; 95 % CI 1.76–4.51; P = .001]. On multivariate analysis, the only predictors of OS were the status of the SLN (HR 2.88; 95 % CI 1.75–4.73) and the presence of satellitosis (HR 2.59; 95 % CI 1.30–5.76). The meta-analysis identified 10 studies that met the inclusion criteria. All reported similar findings, demonstrating a significant difference in OS according to sentinel lymph node status; the pooled analysis of 2104 patients demonstrated an overall HR for OS according to SLNB status of 2.3 (95 % CI 1.95–2.71).

Conclusions

SLNB provides important prognostic information for patients with T4 melanoma. This information is important when stratifying patients for clinical trials.

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References

  1. Balch CM, Gershenwald JE, Soong SJ, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27:6199–206.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Wong SL, Balch CM, Hurley P, et al. Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology joint clinical practice guideline. J Clin Oncol. 2012;30:2912–8.

    Article  PubMed  Google Scholar 

  3. Morton DL, Thompson JF, Cochran AJ, et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med. 2014;370:599–609.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  4. Yamamoto M, Fisher KJ, Wong JY, et al. Sentinel lymph node biopsy is indicated for patients with thick clinically lymph node-negative melanoma. Cancer. 2015;121:1628–36.

    Article  PubMed  Google Scholar 

  5. Gershenwald JE, Mansfield PF, Lee JE, Ross MI. Role for lymphatic mapping and sentinel lymph node biopsy in patients with thick (≥4 mm) primary melanoma. Ann Surg Oncol. 2000;7:160–5.

    Article  PubMed  CAS  Google Scholar 

  6. Carlson GW, Murray DR, Hestley A, Staley CA, Lyles RH, Cohen C. Sentinel lymph node mapping for thick (≥4-mm) melanoma: should we be doing it? Ann Surg Oncol. 2003;10:408–15.

    Article  PubMed  Google Scholar 

  7. Gutzmer R, Satzger I, Thoms KM, et al. Sentinel lymph node status is the most important prognostic factor for thick (≥4 mm) melanomas. J Dtsch Dermatol Ges. 2008; 6: 198–203.

    Article  PubMed  Google Scholar 

  8. Gajdos C, Griffith KA, Wong SL, et al. Is there a benefit to sentinel lymph node biopsy in patients with T4 melanoma? Cancer. 2009;115:5752–60.

    Article  PubMed  Google Scholar 

  9. Scoggins CR, Bowen AL, Martin RC, 2nd, et al. Prognostic information from sentinel lymph node biopsy in patients with thick melanoma. Arch Surg. 2010;145:622–7.

    Article  PubMed  Google Scholar 

  10. Goppner D, Ulrich J, Pokrywka A, Peters B, Gollnick H, Leverkus M. Sentinel lymph node biopsy status is a key parameter to stratify the prognostic heterogeneity of malignant melanoma in high-risk tumors >4.0 mm. Dermatology. 2011;222:59–66.

    Article  PubMed  Google Scholar 

  11. Rughani MG, Swan MC, Adams TS, et al. Sentinel node status predicts survival in thick melanomas: the Oxford perspective. Eur J Surg Oncol. 2012;38:936–42.

    Article  PubMed  CAS  Google Scholar 

  12. Fujisawa Y, Otsuka F, Japanese Melanoma Study G. The benefit of a sentinel lymph node biopsy and adjuvant therapy in thick (>4 mm) melanoma: multicenter, retrospective study of 291 Japanese patients. Melanoma Res. 2012;22:362–7.

    Article  PubMed  CAS  Google Scholar 

  13. Pasquali S, Haydu LE, Scolyer RA, et al. The importance of adequate primary tumor excision margins and sentinel node biopsy in achieving optimal locoregional control for patients with thick primary melanomas. Ann Surg. 2013;258:152–7.

    Article  PubMed  Google Scholar 

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Acknowledgment

The authors wish to thank Ms. Diana Zannino for preliminary statistical assistance.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Australia

    David E. Gyorki MBBS, MD, Alexandra Sanelli MBBS, Alan Herschtal PhD, Smaro Lazarakis BEd(Sec)-Lib, David Speakman MBBS, John Spillane MBBS & Michael A. Henderson MBBS, MD

  2. Department of Surgery, St Vincent’s Hospital, University of Melbourne, Fitzroy, Australia

    David E. Gyorki MBBS, MD & Michael A. Henderson MBBS, MD

  3. Department of Cancer Medicine, Peter MacCallum Cancer Centre, East Melbourne, Australia

    Grant A. McArthur MBBS, PhD

  4. Department of Pathology, University of Melbourne, Parkville, Australia

    Grant A. McArthur MBBS, PhD

  5. Department of Medicine, St Vincent’s Hospital, University of Melbourne, Fitzroy, Australia

    Grant A. McArthur MBBS, PhD

  6. Sir Peter MacCallum Department of Oncology, University of Melbourne, East Melbourne, Australia

    Grant A. McArthur MBBS, PhD

Authors
  1. David E. Gyorki MBBS, MD
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  2. Alexandra Sanelli MBBS
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  3. Alan Herschtal PhD
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  4. Smaro Lazarakis BEd(Sec)-Lib
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  5. Grant A. McArthur MBBS, PhD
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  6. David Speakman MBBS
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  7. John Spillane MBBS
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  8. Michael A. Henderson MBBS, MD
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Corresponding author

Correspondence to David E. Gyorki MBBS, MD.

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Gyorki, D.E., Sanelli, A., Herschtal, A. et al. Sentinel Lymph Node Biopsy in T4 Melanoma: An Important Risk-Stratification Tool. Ann Surg Oncol 23, 579–584 (2016). https://doi.org/10.1245/s10434-015-4894-4

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  • DOI: https://doi.org/10.1245/s10434-015-4894-4

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