Sentinel lymph node biopsy and survival in elderly patients with cutaneous melanoma (Br J Surg 2011; 98: 1400–1407)

✍ Scribed by E. de Bree

• Publisher: John Wiley and Sons
• Year: 2011
• Tongue: English
• Weight: 140 KB
• Volume: 98
• Category: Article
• ISSN: 0007-1323
• DOI: 10.1002/bjs.7591

✦ Synopsis

Background: Sentinel lymph node biopsy (SNB) is a widely adopted staging procedure in patients with cutaneous melanoma. The benefits of SNB have not been evaluated thoroughly in older age groups.

Methods: This was a two-centre retrospective observational study of patients with melanoma aged at least 70 years undergoing SNB. Results: A total of 423 patients were included. SNB was successful in 405 patients (95•7 per cent), of whom 88 (21•7 per cent) had sentinel node metastasis. During a median follow-up of 2•5 years, recurrence developed in 80 patients (18•9 per cent). Nodal recurrence developed in eight sentinel node-negative patients, giving a false-negative rate of 8•3 per cent, a sensitivity of 91•7 per cent and an overall diagnostic accuracy of 98•0 per cent. A total of 46 patients (10•9 per cent) died from melanoma and 42 (9•9 per cent) from other causes. At 5 years, the relapse-free survival rate was 80•0 per cent in sentinel node-negative patients and 39 per cent in node-positive patients; cancer-specific survival rates were 88•6 per cent and 46 per cent respectively (P < 0•001). In multivariable analysis, sentinel node metastasis (P < 0•001), a Breslow thickness of at least 2•0 mm (P = 0•007) and presence of ulceration (P = 0•012) were independent prognostic factors for cancer-specific survival. Conclusion: SNB is a feasible and accurate technique for detecting nodal metastases in older patients with melanoma. Sentinel node status is the most important predictor of cancer-specific outcome in the elderly.