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Sentinel Node Biopsy Provides More Accurate Staging Than Elective Lymph Node Dissection in Patients With Cutaneous Melanoma

From the Sydney Melanoma Unit, the Melanoma and Skin Cancer Research Institute, the Department of Surgery of the University of Sydney (AD, WHM, JFT); the Department of Anatomical Pathology, Royal Prince Alfred Hospital (RAS), Sydney, New South Wales, Australia; and the Daniel den Hoed Cancer Center (JHWdW), Rotterdam, the Netherlands.

Correspondence: Address correspondence and reprint requests to: J.F. Thompson, MD, Sydney Melanoma Unit, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia; Fax: 61-2-9550-6316; E-mail: thompson{at}smu.org.au

Background: In most major melanoma treatment centers, sentinel node biopsy (SNB), with complete regional lymph node dissection when a positive sentinel node is found, has now replaced elective lymph node dissection (ELND) for patients with primary cutaneous melanomas who are considered to be at moderate to high risk of nodal recurrence. As for ELND, however, no overall survival benefit for the SNB procedure has yet been demonstrated. The objective of this study was to compare the nodal staging accuracy and duration of survival for SNB and ELND.

Methods: A retrospective cohort study was conducted among patients with American Joint Committee on Cancer (AJCC) stage II disease treated at a single center between 1983 and 2000 with either SNB (n = 672) or ELND (n = 793). Multivariate analyses were performed using the logistic regression model for nodal staging accuracy and Cox’s proportional hazards regression model for survival.

Results: Patient factors that influenced nodal positivity included age, Breslow thickness, ulceration, head or neck primary, and operation type (SNB or ELND). SNB was superior to ELND in the detection of micrometastases (odds ratio 1.23, 95% CI, 1.06 – 1.43) but operation type did not influence survival (P = .24).

Conclusions: Sentinel node biopsy identified more nodal micrometastases than ELND but did not influence survival, although complete regional node dissection was performed in all patients who were SNB positive. This increase in staging accuracy likely results from the reliable identification of the appropriate lymph node field by preoperative lymphoscintigraphy, along with more detailed pathologic examination of the nodes removed by SNB.

Key Words: Melanoma • Elective lymph node dissection • Sentinel lymph node • Staging

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