Rughani, M. G., Swan, M. C., Adams, T. S., Marshall, A. (Andrea), Asher, R., Cassell, O. C. and Middleton, M. (Mark). (2012) Sentinel node status predicts survival in thick melanomas : the Oxford perspective. European Journal of Surgical Oncology (EJSO), Vol.38 (No.10). pp. 936-942. ISSN 0748-7983

Abstract

Aims To determine the prognostic value of SLNB in patients with thick melanoma in terms of overall survival (OS) and recurrence-free survival (RFS). Methods 136 patients with primary tumours (Breslow thickness ≥4.0 mm) underwent SLNB. OS and RFS were calculated and a multivariate Cox regression model used to determine the important prognostic factors for predicting OS and RFS. Results Median Breslow thickness was 5.5 mm and 60% were ulcerated. Median follow up was 4 years (95% CI = 4–5) with 54 patients having died at the time of analysis. 5-year OS for SLNB positive patients was 32%, compared to 78% for negative patients. The significant predictors of poorer OS were increasing age (p = 0.03), increasing Breslow thickness (p = 0.03) and SLNB positivity (p < 0.0001). 5 year RFS was significantly worse in the SLNB positive population compared to the negative patients (p < 0.0001); 27% versus 66% respectively. Conclusions Patients with a thick melanoma and a positive SLNB have a significantly worse RFS and OS compared to those with a negative SLNB. Over three-quarters of patients with a negative SLNB survived five years. These findings have implications for the subpopulations included in adjuvant therapy trials and we advocate SLNB be recommended in patients with thick melanomas.

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