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Prognostic Implications of Thick (4-mm) Melanoma in the Era of Intraoperative Lymphatic Mapping and Sentinel Lymphadenectomy

From the Roy E. Coats Research Laboratories of the John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, California.

Correspondence: Address correspondence and reprint requests to: Richard Essner, MD, John Wayne Cancer Institute, 2200 Santa Monica Blvd., Santa Monica, CA 90404; Fax: 310-449-5259; E-mail: essner{at}jwci.org

Background: Lymphatic mapping/sentinel lymphadenectomy (LM/SL) has become a routine part of our treatment algorithm for primary melanoma, yet its role in the management of thick (4-mm) lesions is unknown.

Methods: One hundred twenty-one patients with thick primaries underwent LM/SL at our institute. Survival curves were constructed from Kaplan-Meier estimates and analyzed by Cox proportional hazards methods.

Results: Sixty-three percent of patients were men, median age 54 years. The primary tumor sites were trunk (46%), extremities (32%), and head and neck (21%). Primary thickness ranged from 4 to 15 mm (median, 6.0 mm). Forty-five percent of primary tumors were ulcerated. Thirty-five percent of patients had tumor-positive dissections. Median follow-up was 31 months. The overall 5-year survival was no different (P = .726) for ulcerated and nonulcerated lesions. There was no difference (P = .159) in overall survival after tumor-negative (60% ± 7%) and tumor-positive (50% ± 10%) dissections. The 5-year disease-free survival was significantly (P = .012) lower in patients with tumor-positive (34% ± 9%) than tumor-negative (47% ± 7%) dissections.

Conclusions: Although LM/SL has become a popular technique for staging the regional lymph nodes in early-stage melanoma, our results suggest that sentinel node status is predictive of disease-free survival for thick primary tumors but is not yet reflective of overall survival. The role of LM/SL for patients with thick primary tumors is not clearly defined.

Key Words: Malignant melanoma • Lymph node dissection • Sentinel lymph node • Metastasis—Thick primaries

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