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Outcome Following Sentinel Node Biopsy Plus Wide Local Excision Versus Wide Local Excision Only for Primary Cutaneous Melanoma: Analysis of 5840 Patients Treated at a Single Institution

van der Ploeg, Augustinus P. T. MD*; Haydu, Lauren E. BSCHE, MIPH*,†; Spillane, Andrew J. MD*,†; Quinn, Michael J. MBBS*,†; Saw, Robyn PM. MBMS*,†; Shannon, Kerwin F. MBBS*,†; Stretch, Jonathan R. MBBS, DPhil(Oxon)*,†; Uren, Roger F. MD*,†,‡; Scolyer, Richard A. MD*,†; Thompson, John F. MD*,†

doi: 10.1097/SLA.0000000000000500
Original Articles

Objective: Worldwide, sentinel node biopsy (SNB) is now a standard staging procedure for most patients with melanomas 1 mm or more in thickness, but its therapeutic benefit is not clear, pending randomized trial results. This study sought to assess the therapeutic benefit of SNB in a large, nonrandomized patient cohort.

Methods: Patients with primary melanomas 1.00 mm or more thick or with adverse prognostic features treated with wide local excision (WLE) at a single institution between 1992 and 2008 were identified. The outcomes for those who underwent WLE plus SNB (n = 2909) were compared with the outcomes for patients in an observation (OBS) group who had WLE only (n = 2931). Median follow-up was 42 months.

Results: Melanoma-specific survival (MSS) was not significantly different for patients in the SNB and OBS groups. However, a stratified univariate analysis of MSS for different thickness subgroups indicated a significantly better MSS for SNB patients with T2 and T3 melanomas (>1.0 to 4.0 mm thick) (P = 0.011), but this was not independently significant in multivariate analysis. Compared with OBS patients, SNB patients demonstrated improved disease-free survival (DFS) (P < 0.001) and regional recurrence-free survival (P < 0.001). There was also an improvement in distant metastasis-free survival (DMFS) for SNB patients with T2 and T3 melanomas (P = 0.041).

Conclusions: In this study, the outcome for the overall cohort after WLE alone did not differ significantly from the outcome after additional SNB. However, the outcome for the subgroup of patients with melanomas more than 1.0 to 4.0 mm in thickness was improved if they had a SNB, with significantly improved disease-free and DMFS.

This study assessed the benefits of sentinel node biopsy (SNB) in melanoma patients. Overall melanoma-specific survival following wide local excision was not significantly different from that following SNB. However, there were better outcomes following SNB for patients with melanomas more than 1.0 to 4.0 mm in thickness, with significantly improved disease-free and distant metastasis-free survival.

*Melanoma Institute Australia

Sydney Medical School, The University of Sydney, Sydney

Nuclear Medicine and Diagnostic Ultrasound, RPAH Medical Centre, Newtown, New South Wales, Australia.

Reprints: John F. Thompson, MD, Melanoma Institute Australia, 40 Rockland Roads, North Sydney, NSW 2060, Australia. E-mail: john.thompson@melanoma.org.au.

A.P.T.v.d.P. and L.E.H. contributed equally to this study.

Disclosure: A.P.T.v.d.P. received travel support from Erasmus Medical Center. R.A.S. received grant support from the National Health and Medical Research Council of Australia (Institutional); and from Cancer Institute New South Wales (Institutional); board membership from Roche, GlaxoSmith Kline, Abbott Molecular; consultancy from Novartis; and travel assistance from Taiwanese Dermatology Association. J.F.T. discloses committee membership of GlaxoSmith Kline, board membership of GlaxoSmith Kline, consultancy from GlaxoSmith Kline, Provectus, and travel assistance from GlaxoSmith Kline. Other authors have nothing to disclose. No funding has been received from any organization.

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© 2014 by Lippincott Williams & Wilkins.