Sentinel Node Biopsy in Thin and Thick Melanoma

Abstract

Although sentinel node biopsy (SNB) has become standard of care in patients with melanoma, its use in patients with thin or thick melanomas remains a matter of debate. This was a retrospective analysis of patients with thin (≤1mm) or thick (≥4mm) melanomas who underwent SNB at two Italian centers between 1998 and 2011. The associations of clinicopathologic features with sentinel lymph node positive status and overall survival (OS) were analyzed. In 492 patients with thin melanoma, sentinel node was positive for metastatic melanoma in 24 (4.9%) patients. No sentinel node positivity was detected in patients with primary tumor thickness <0.3mm. Mitotic rate was the only factor significantly associated with sentinel node positivity (p=0.0001). Five-year OS was 81% for patients with positive sentinel node and 93% for negative sentinel node (p=0.001). In 298 patients with thick melanoma, 39% of patients had positive sentinel lymph nodes (median Breslow thickness 5mm). In patients with positive sentinel node, 93% had mitotic rate >1/mm(2). Five-year OS was 49% for patients with positive sentinel lymph nodes and 56% for patients with negative sentinel nodes (p=0.005). The rate of sentinel node positivity in patients with thin melanoma was 4.9%. The only clinicopathologic factor related to node positivity was mitotic rate. Given its prognostic importance, SNB should be considered in such patients. SNB should also be the standard method for melanoma ≥4mm, not only for staging, but also for guiding therapeutic decisions.