Between the years 2000–2010, 195 patients were diagnosed with ≥4 mm Breslow thickness malignant melanoma in our unit. Median follow-up was 36.8 months. 49% of patients were male and 51% were female. Median age was 74 years. The commonest melanoma type was nodular (55%). The commonest tumour location was on the extremity (45%). 64% of tumours were ulcerated. Median mitotic rate was 9. Median Breslow thickness was 7 mm 66 patients underwent sentinel lymph node biopsy. 44 (67%) patients had negative results and the remaining 22 (33%) patients were positive for metastatic melanoma. There was no statistically significant correlation between any of the patient or tumour variables (age, sex, melanoma type, melanoma site, Clark level, Breslow thickness, mitotic rate, ulceration) and sentinel lymph node status. Patients with Breslow thickness melanoma of <6 mm had a significantly better 5-year disease free and overall survival compared with those patients with >6 mm Breslow thickness melanoma (63.5% vs. 32.9%; P = 0.004 and 73.9% vs. 54.7%; P = 0.02 respectively). Recurrence rate was 50% in those with positive sentinel lymph node biopsy compared to 23% in those with negative results. Distant recurrence was the commonest in both groups. 5-year disease free survival was 64.1% in the SLNB –ve group and 35.4% in the SLNB +ve group (P = 0.01). There was no significant difference in overall survival between the SLNB –ve and SLNB +ve groups (70.3% vs. 63.7% respectively; P = 0.66). We conclude that sentinel lymph node biopsy in our unit has provided no survival benefit in those with thick melanoma over the past 10 years but is an important predictor of recurrence free survival. Breslow thickness remains an important predictor of disease free and overall survival in thick melanoma.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Plastic, Reconstructive & Aesthetic Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Sentinel lymph node biopsyfor early stage melanoma: accuracy and morbidity in MSLT-1, an international multi-centre trial.Ann Surg. 2005; 242: 302-311
- Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel node status in 612 stage I or II melanoma patients.J Clin Oncol. 1999; 17: 976-983
- The prognosis of patients with thick primary melanoma: is regional lymph node status relevant, and does removing positive regional nodes influence outcome?.Ann Surg Oncol. 2002; 9: 719-722
- Sentinel lymph node biopsy in melanoma delays recurrence but does not change melanoma related survival: a retrospective analysis of 673 patients.Br J Dermatol. 2005; 153: 1137-1141
- Role for lymphatic mapping and seninel lymph node biopsy in patients with thick (≥4 mm) primary melanoma.Ann Surg Oncol. 2000; 7: 160-165
- Role of sentinel lymph node biopsy in patients with thick (>4 mm) primary melanoma.Am Surg. 2004; 70: 59-62
- Sentinel lymph node mapping for thick (≥4 mm) melanoma: should we be doing it?.Ann Surg Oncol. 2003; 10: 408-415
- Is there a benefit to sentinel lymph node biopsy in patients with T4 melanoma?.Cancer. 2009; 115: 5752-5760
- The impact of factors beyond Breslow depth on predicting sentinel lymph node positivity in melanoma.Cancer. 2007; 109: 100-108
- Predicting sentinel node status in AJCC stage 1/11 primary cutaneous melanoma.Cancer. 2006; 107: 2436-2445
- Melanoma thickness and histology predict sentinel lymph node status.Am J Surg. 2001; 181: 8-11
- Sentinel lymph node biopsy in the management of patients with primary cutaneous melanoma: review of a large single-institutional experience with an emphasis on recurrence.Ann Surg. 2001; 233: 250-258
- Should tumour mitotic rate and patient age, as well as tumour thickness, be used to elect melanoma patients for sentinel lymph node biopsy?.Ann Surg Oncol. 2004; 11: 233-235
- Final version of 2009 AJCC melanoma staging and classification.J Clin Oncol. 2009; 27: 6199-6206
- Multivariate analysis of prognosptic factors among 2313 patients with stage II melanoma: comparison of nodal micrometastases versus macrometastases.J Clin Oncol. 2010; 28: 2452-2459
- Prognostic role sentinel lymph node biopsy patient thick melanoma a meta-analysis.J Eur Acad Dermatol Venereol. 2011; ([Epub ahead of print])
- Thick primary melanoma has a heterogenous tumour biology: an institutional series.World J Surg Oncol. 2011 Apr 14; 9: 40
- Prognostic information from sentinel lymph node biopsy in patients with thick melanoma.Arch Surg. 2010 Jul; 145 (2nd): 622-627
- Sentinel-node biopsy or nodal observation in melanoma.N Eng J Med. 2006 Sep 28; 355: 1307-1317
- Prognostic implications of thick (≥4 mm) melanoma in the era of intraoperative lymphatic mapping and sentinel lymphadenectomy.Ann Surg Oncol. 2002; 9: 754-761
- Efficacy of lymphatic mapping, sentinel lymphadenectomy, and selective complete lymph node dissection as a therapeutic procedure for early stage melanoma.Ann Surg Oncol. 1999; 6: 442-449
- Survival analysis and clinicopathological factors associated with false-negative sentinel lymph node biopsy findings in patients with cutaneous melanoma.Ann Surg Oncol. 2006 Dec; 13: 1655-1663
Published online: May 03, 2012
Accepted: April 12, 2012
Received: November 18, 2011
☆Article presented at BAPRAS Winter Scientific Meeting 2011.
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.