Comparison of the use and results of sentinel lymph node biopsy in children and young adults with melanoma

Abstract

Data on sentinel lymph node (SLN) biopsy in children with melanoma are limited. In this study, the authors compared the factors associated with SLN biopsy use and metastases in pediatric and young adult patients with melanoma. The 2008 Surveillance, Epidemiology, and End Results (SEER) databases were used to examine melanoma cases from 2003 to 2008. Data extracted include age, sex, race, stage, tumor thickness, ulceration, lymph node status, surgical treatment, and survival. Logistic regression models were used for adjusted analyses. In total, 717 children (age <20 years) and 1368 young adults (age 20-24 years) were identified who were diagnosed with melanoma. Factors that were associated with SLN biopsy use included tumor ulceration (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.4-4.3) and greater thickness (OR, 17; 95% CI, 12-24 for >1 mm vs ≤1 mm), but not younger age (OR, 1.3; 95% CI, 0.94-1.8) in adjusted analyses. SLN metastasis was correlated with ulceration (OR, 3.0; 95% CI, 1.6-5.8), increased thickness (OR, 6.8; 95% CI, 3.1-15 for 2.01-4.0 mm vs ≤1 mm), and for the interaction between age <20 years and thickness 1.01 to 2.00 mm (OR, 6.5; 95% CI, 1.7-25) in adjusted analyses. Children with nonulcerated melanomas that measured 1.01 to 2.00 mm in thickness were significantly more likely to have SLN metastases than young adults (24% vs 4%; P < .001). Thickness and ulceration were strong predictors of both the use of SLN biopsy and positive SLN biopsy results in children and young adults with melanoma. Compared with young adults, children were more likely to have SLN metastases despite having similar rates of SLN biopsy use.