Patient age an important factor in estimating sentinel lymph node risk in patients with intermediate thickness melanoma
September 14, 2018
Abstract
Importance: There is large variability in the risk of sentinel lymph node (SLN) positivity among intermediate thickness melanoma (ITM) patients, with a subgroup of patients exhibiting low risk of nodal disease.
Objective: To identify a group of ITM patients for whom risk of nodal disease is low.
Methods: A retrospective cohort of ITM patients who underwent wide excision and nodal evaluation from 2010 to 2013 using the National Cancer Database was analyzed for the presence of nodal disease. Classification and regression tree (CART) analysis identified the most important factors used in a model to identify low risk groups of SLN positivity.
Results: Of 23,440 patients, 14.7% were found to have nodal metastasis. On CART analysis, patients older than 55 without lymphovascular invasion and lesion thickness < 1.7 mm had a SLN positivity rate of 4.9%. A model using age and thickness in non-ulcerated patients identified a low risk subgroup with a corresponding SLN positivity rate of 4.7%.
Limitations: This is a retrospective study and the model developed requires prospective validation.
Conclusions: Patient age is an important factor in estimating SLN risk in patients with ITM and may help identify patients without ulceration that may be safely spared a SLN biopsy.
Source:
Andrew N. Hanna, Andrew J. Sinnamon, Robert E. Roses, Rachel R. Kelz, David E. Elder, Xiaowei Xu, Barbara A. Pockaj, Jonathan S. Zager, Douglas L. Fraker, Giorgos C. Karakousis,
Relationship between Age and Likelihood of Lymph Node Metastases in Patients with Intermediate Thickness Melanoma (1.01 - 4.00 mm): A National Cancer Database Study,
Journal of the American Academy of Dermatology, 2018, ISSN 0190-9622, https://doi.org/10.1016/j.jaad.2018.08.022.