Sentinel Lymph Node Biopsy in Patients with Thick Primary Cutaneous Melanoma: Patterns of Use and Underuse Utilizing a Population-Based Model

Steve R. Martinez,Emanual Maverakis,Dhruvil R. Shah,Robert J. Canter,Anthony D. Yang

doi:10.1155/2013/315609

Steve R. Martinez, Emanual Maverakis + Show 3 more

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https://doi.org/10.1155/2013/315609

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Journal: ISRN dermatology	Publication Date: Jan 10, 2013
Citations: 12	License type: CC BY 3.0

Affiliation: University of California, Davis

Abstract

Background. Sentinel lymph node biopsy (SLNB) for thick cutaneous melanoma is supported by national guidelines. We report on factors associated with the use and underuse of SLNB for thick primary cutaneous melanoma. Methods. The Surveillance, Epidemiology, and End Results database was queried for patients who underwent surgery for thick primary cutaneous melanoma from 2004 to 2008. We used multivariate logistic regression models to predict use of SLNB. Results. Among 1,981 patients, 833 (41.8%) did not undergo SLNB. Patients with primary melanomas of the arm (OR 2.07, CI 1.56–2.75; P < 0.001), leg (OR 2.40, CI 1.70–3.40; P < 0.001), and trunk (OR 1.82, CI 1.38–2.40; P < 0.001) had an increased likelihood of receiving a SLNB, as did those with desmoplastic histology (OR 1.47, CI 1.11–1.96; P = 0.008). A decreased likelihood of receiving SLNB was noted for advancing age ≥ 60 years (age 60 to 69: OR 0.58, CI 0.33–0.99, P = 0.047; age 70 to 79: OR 0.32, CI 0.19–0.54, P < 0.001; age 80 or more: OR 0.10, CI 0.06–0.16, P < 0.001) and unknown race/ethnicity (OR 0.21, CI 0.07–0.62; P = 0.005). Conclusions. In particular, elderly patients are less likely to receive SLNB. Further research is needed to assess whether use of SLNB in this population is detrimental or beneficial.

Highlights

Lymphatic mapping and sentinel lymph node biopsy (SLNB) was developed by Morton et al as an alternative to elective lymph node dissection for patients with intermediate thickness melanoma [1]
We looked at the proportion of patients receiving SLNB for their thick cutaneous melanoma by year of diagnosis. ere was a general trend towards increasing utilization of SLNB, with 50.8% of patients having the procedure in 2004, 58% in 2005, 56.4% in 2006, 63.5% in 2007, and 61.1% having it in 2008
Despite the fact that SLNB for lymph node staging of thick primary cutaneous melanomas has been advocated by national guidelines since 1998 [13] and supported by retrospective and prospective institutional data [2,3,4,5,6,7,8,9,10,11], its use in this setting is frequently cited as controversial

Summary

Introduction

Lymphatic mapping and sentinel lymph node biopsy (SLNB) was developed by Morton et al as an alternative to elective lymph node dissection for patients with intermediate thickness melanoma [1]. Current guidelines from the National Comprehensive Cancer Network (NCCN) advocate the SLNB for all melanomas >1 mm in thickness [12]. Such guidelines have been in place since 1998 [13]. We report on factors associated with the use and underuse of SLNB for thick primary cutaneous melanoma. Patients with primary melanomas of the arm (OR 2.07, CI 1.56–2.75; PP P PPPPP), leg (OR 2.40, CI 1.70–3.40; PP P PPPPP), and trunk (OR 1.82, CI 1.38–2.40; PP P PPPPP) had an increased likelihood of receiving a SLNB, as did those with desmoplastic histology (OR 1.47, CI 1.11–1.96; PP P PPPPP). Further research is needed to assess whether use of SLNB in this population is detrimental or bene cial

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