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Abstract
Simple SummaryThe aim of the present study was to investigate long-term outcomes of melanoma patients who had micrometastasis on sentinel lymph node (SLN) biopsy. We focused on the comparison between melanoma patients with and without complete lymph node dissection (CLND) following a positive SLN biopsy result. Patients without CLND did not significantly differ from patients with CLND in regard to age, gender, tumor thickness, tumor ulceration, capsule infiltration of SLN, and invasion level of SLN. On 10-year analysis, we did not observe a significantly increased risk for melanoma relapse or melanoma-specific death in patients who did not undergo CLND after the detection of micrometastases on SLN biopsy. On 20-year analysis, again, the patients without CLND had no significantly increased risk of melanoma relapse and worse melanoma-specific survival. Hence, our 10-year survival data confirm the current notion that waiving CLND in SLN-positive patients does not result in clinical disadvantages with respect to melanoma-specific survival. For the first time, we demonstrate on 20-year survival analysis that relapse rates and melanoma-specific survival does not significantly differ between patients with or without CLND on long-term follow-up.Complete lymph node dissection (CLND) following positive sentinel lymph node (SLN) biopsy has been the standard of care for decades. We aimed to study melanoma patients with an emphasis on the outcome of patients with versus without CLND following positive SLN biopsy. SLN-positive patients with or without CLND were compared regarding important prognostic clinical and histological characteristics. Ten-year and 20-year survival curves for melanoma relapse and melanoma-specific survival (MSS) were determined by the Kaplan-Meier method and Cox proportional-hazards regression. We studied 258 patients who had micrometastases in their SLN biopsy. CLND was performed in 209 of 258 patients (81%). Hence, in 49 of 258 patients (19%) with SLN micrometastases, CLND was not performed. These patients did not significantly (p > 0.05) differ from patients with CLND in regard to age, gender, tumor thickness, tumor ulceration, capsule infiltration of SLN, or invasion level of SLN. On 10-year analysis, we did not observe a significantly increased risk for melanoma relapse and worse in MSS in patients who did not undergo CLND (hazard ratio: 1.1 (95% CI 0.67 to 1.7) and 1.1 (95% CI 0.67 to 1.9), respectively). On 20-year survival analysis, we confirmed that the risk of melanoma relapse and impaired MSS does not significantly increase in patients without CLND (hazard ratio: 1.2 (95% CI 0.8 to 1.9) and 1.3 (95% CI 0.8 to 2.3), respectively). On 10-year as well as 20-year multivariable follow-up analysis (including several important prognostic factors), Cox proportional-hazards regression showed that the status of CLND did not remain in the regression model (p > 0.1). Our 10-year data give conclusive support to previous investigations indicating that waiving CLND in patients with SLN micrometastases does not affect MSS. More importantly, our long-term follow-up data confirm for the first time the 10-year survival data of previous investigations.
Highlights
Cutaneous melanoma is associated with more than 55,000 deaths per annum worldwide
We report our single center long-term experience in patients who had undergone SLNB, focusing on the question of whether waiving Complete lymph node dissection (CLND) following a positive SLNB is a disadvantage with respect to melanoma relapse and melanoma-specific survival (MSS)
We identified 929 melanoma patients [males: 430 (46.3%); females: 499 (53.7%); median age was 58 years, range: 15–90 years)] who had undergone SLNB
Summary
Cutaneous melanoma is associated with more than 55,000 deaths per annum worldwide. Despite the advent of novel effective therapies, such as immune and targeted therapy, melanoma remains a life-threatening disease once it cannot be cured by surgery alone [1,2]. Sentinel lymph node (SLN)-biopsy (SLNB) is a proven and reliable prognostic tool. As reported in the second Multicenter Selective Lymphadenectomy Trial (MSLT-2) [3,4], the 10-year melanoma-specific survival (MSS) of patients with intermediatethickness melanomas (1.2–3.5 mm) was 85.1% for SLN-negative and 62.1% for SLN-positive patients (p = 0.0001). SLNB is performed starting at a Breslow tumor thickness of 1 mm. Thinner (0.75 mm) melanomas with ulceration, patient-age under 40 years, and increased mitosis index are recommended for SLNB on an individual basis. In patients with thicker melanomas, 10-year MSS was 64.4% for negative SLN and 48.0% (p = 0.03) for positive SLN. SLN-status frequently proved to be a strong predictor of MSS [1,2,3,4,5]
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