Use of sentinel lymph node biopsy for melanoma in children and adolescents

Abstract

Though sentinel lymph node biopsy (SLNB) is an integral component of melanoma staging, little is known about its use in children. Patients (0-18 years) with melanoma diagnosed from 2003 to 2007 in the National Cancer Data Base were assessed. Logistic regression models were used to identify clinicopathologic, socioeconomic, and hospital factors associated with SLNB use and lymph node metastases (LNM). Of 671 children, 68.7% underwent SLNB. SLNB utilization rates were 39.9% for T1a patients and 87.6% for T1b-T3 patients. T1b-T3 patients were more likely to undergo SLNB if they were older (OR 4.86 95% CI: 1.88-12.59) or cared for at Children's hospitals (OR 2.43 95% CI: 1.09-5.40). T1b-T3 patients were less likely to undergo SLNB if uninsured (OR 0.25 95% CI: 0.08-0.76). Of those with SLNB, 118 (25.6%) had pathologically confirmed LNM. Patients were more likely to have LNM if younger (OR 3.19 95% CI: 1.20-8.51) or having higher T stage (OR 10.38 95% CI: 4.59-23.47). SLNB use for children with melanoma was associated with clinicopathologic, socioeconomic, and hospital factors. Younger patients have a higher likelihood of LNM but are the least likely to undergo SLNB. Though overall adherence appears high, there remains an opportunity for improved care for children with melanoma.