Sentinel Lymph Node Biopsy vs. Observation in Thin Melanoma: A Multicenter Propensity Score Matching Study.

Antonio Tejera‐Vaquerizo ,Aram Boada,Isidro Bolumar,Paola Cassoni,Sabela Paradela,Josep Malvehy,Susana Puig,Ramón Pigem,Sergi Vidal-Sicart,Celia Requena,Ane Jaka,Ricardo Vieira,Ana Brinca,Simone Ribero,Víctor Traves,Carlos Ferrándiz,Pietro Quaglino,Javier Cañueto,Eduardo Nagore,Cristina Carrera,Simona Osella‐Abate ,Miguel Ángel Descalzo ,Llúcia Alós ,Nina A Richarz ,Almudena Fernández‐Orland ,Alba Toll ,N Iglesias-Pena ,D Moreno‐Ramírez ,Sebastián Podlipnik ,Concepción Román‐Curto ,L Ferrándiz-Pulido ,R Rull ,Rafael Botella‐Estrada ,Ángel Plá ,Blanca De Unamuno‐Bustos ,María Teresa Fernández‐Figueras

doi:10.3390/jcm10245878

Abstract

The therapeutic value of sentinel lymph node biopsy (SLNB) in thin melanoma remains controversial. The aim of this study is to determine the role of SLNB in the survival of thin melanomas (≤1 mm). A multicenter retrospective observational study was designed. A propensity score matching was performed to compare patients who underwent SLNB vs. observation. A multivariate Cox regression was used. A total of 1438 patients were matched by propensity score. There were no significant differences in melanoma-specific survival (MSS) between the SLNB and observation groups. Predictors of MSS in the multivariate model were age, tumor thickness, ulceration, and interferon treatment. Results were similar for disease-free survival and overall survival. The 5- and 10-year MSS rates for SLN-negative and -positive patients were 98.5% vs. 77.3% (p < 0.001) and 97.3% vs. 68.7% (p < 0.001), respectively. SLNB does not improve MSS in patients with thin melanoma. It also had no impact on DSF or OS. However, a considerable difference in MSS, DFS, and OS between SLN-positive and -negative patients exists, confirming its value as a prognostic procedure and therefore we recommend discussing the option of SLNB with patients.

Highlights

Sentinel lymph node biopsy (SLNB) is a commonly used procedure in the management of cutaneous melanoma [1]
1438 patients were matched by propensity scores
The corresponding 5- and 10-year rates for disease-free survival (DFS) were 95.3% vs. 94.3% and 90.8% vs. 91.8%

Summary

Introduction

Sentinel lymph node biopsy (SLNB) is a commonly used procedure in the management of cutaneous melanoma [1]. The Multicenter Selective Lymphadenectomy Trial I (MSTL-I) showed that SLNB does not improve disease-specific survival in melanoma (MSS) [2], it did not include tumors with a Breslow thickness < 1.2 mm in the analysis. The therapeutic effect of SLNB in thin melanoma remains to be determined. This is important, in our setting, where tumors with a Breslow thickness < 1 mm are the most common diagnosed melanomas [3]. The main aim of this study was to determine whether SLNB improves MSS in patients with thin tumors. Secondary objectives were to compare disease-free survival (DFS) and overall survival (OS) between patients who undergo SLNB and those who undergo observation and to examine the effect of SLN positivity on survival

Objectives

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Results

Conclusion