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Byron E. Wright, MD; Randall P. Scheri, MD; Xing Ye, MS; Mark B. Faries, MD; Roderick R. Turner, MD; Richard Essner, MD; Donald L. Morton, MD

Arch Surg. 2008;143(9):892-900.

Hypothesis  The status of the sentinel node (SN) confers important prognostic information for patients with thin melanoma.

Design, Setting, and Patients  We queried our melanoma database to identify patients undergoing sentinel lymph node biopsy for thin (1.00-mm) cutaneous melanoma at a tertiary care cancer institute. Slides of tumor-positive SNs were reviewed by a melanoma pathologist to confirm nodal status and intranodal tumor burden, defined as isolated tumor cells, micrometastasis, or macrometastasis (0.20, 0.21-2.00, or >2.00 mm, respectively). Nodal status was correlated with patient age and primary tumor depth ( 0.25, 0.26-0.50, 0.51-0.75, or 0.76-1.00 mm). Survival was determined by log-rank test.

Main Outcome Measures  Disease-free and melanoma-specific survival.

Results  Of 1592 patients who underwent sentinel lymph node biopsy from 1991 to 2004, 631 (40%) had thin melanomas; 31 of the 631 patients (5%) had a tumor-positive SN. At a median follow-up of 57 months for the 631 patients, the mean (SD) 10-year rate of disease-free survival was 96% (1%) vs 54% (10%) for patients with tumor-negative vs tumor-positive SNs, respectively (P < .001); the mean (SD) 10-year rate of melanoma-specific survival was 98% (1%) vs 83% (8%), respectively (P < .001). Tumor-positive SNs were more common in patients aged 50 years and younger (P = .04). The SN status maintained importance on multivariate analysis for both disease-free survival (P < .001) and melanoma-specific survival (P < .001).

Conclusions  The status of the SN is significantly linked to survival in patients with thin melanoma. Therefore, sentinel lymph node biopsy should be considered to obtain complete prognostic information.

Author Affiliations: Departments of Surgical Oncology (Drs Wright, Scheri, Faries, Essner, and Morton), Biostatistics (Ms Ye), and Pathology (Dr Turner), John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California.

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