Sentinel Lymph Node Biopsy Is Prognostic in Thickest Melanoma Cases and Should Be Performed for Thick Melanomas. Academic Article uri icon


  • BACKGROUND: Sentinel lymph node biopsy (SLNB) is recommended for intermediate thickness melanoma, but for thick melanoma, guidelines are less definitive about the use of SLNB in this population. We present a study on thick melanoma evaluating for prognostic factors. PATIENTS AND METHODS: The Sentinel Lymph Node Working Group database was queried for thick (>4mm) melanoma cases that had a SLNB from 1993 to 2018. Clinicopathologic characteristics were correlated with SLN status and melanoma-specific survival (MSS). RESULTS: There were 1235 patients. Median follow-up was 28months. Median thickness was 5.9mm, with 956, 175, and 104 cases presenting thickness>4-8,>8-12, and>12mm, respectively. SLN metastases were seen in 439 of 1235 (35.5%) cases and in 33.9%, 40.6%, and 42.3% of melanomas>4-8,>8-12, and>12mm, respectively. In each thickness group, MSS was significantly worse for SLN-positive compared with SLN-negative cases (all P<0.005). Multivariable analysis showed that SLN metastasis, male gender, increasing thickness, lymphovascular invasion, and microsatellitosis significantly predicted worse MSS for melanomas>4-8mm, with SLN metastasis showing the greatest risk (HR 2.17, 95% CI 1.64-2.87, P<0.0001). For melanomas>8mm, only SLN metastasis significantly predicted MSS (>8-12mm: HR 3.93, 95% CI 2.00-7.73, P<0.0001;>12mm: HR 3.58, 95% CI 1.56-8.22, p<0.0027). CONCLUSIONS: Thick melanoma patients with SLN metastasis have significantly worse MSS compared with SLN-negative patients, even in the thickest cases, and SLN status is the most powerful and/or only predictor of MSS. Given these results, SLNB shows important prognostic value in this population and is indicated for clinically localized thick melanoma.

published proceedings

  • Ann Surg Oncol

altmetric score

  • 7.75

author list (cited authors)

  • Han, D., Han, G., Duque, M. T., Morrison, S., Leong, S. P., Kashani-Sabet, M., ... Zager, J. S.

citation count

  • 11

complete list of authors

  • Han, Dale||Han, Gang||Duque, Monica T||Morrison, Steven||Leong, Stanley P||Kashani-Sabet, Mohammed||Vetto, John||White, Richard||Schneebaum, Schlomo||Pockaj, Barbara||Mozzillo, Nicola||Sondak, Vernon K||Zager, Jonathan S

publication date

  • February 2021