Sentinel Node Biopsy Not Useful for Many With Cutaneous Melanoma

Sentinel lymph node biopsy (SLNB) is variably useful for melanoma patients with localized disease and clinically negative nodes if they have tumors of intermediate thickness, but is not useful for those with thin or thick tumors, according to a new analysis of published research.

Dr. Arthur R. Rhodes of Rush University in Chicago found no survival benefit for lymphatic mapping with SLNB, with therapeutic lymph node dissection (TLND) for positive nodes.

However, SLNB is still being recommended for patients with cutaneous melanoma based on questionable, “optimistic” interpretations of secondary outcomes from the Multi-center Selective Lymphadenectomy Trial (MSLT), according to a report in a December 20 online publication of the Archives of Dermatology.

“A clinical test that accurately predicts patient outcome for localized primary invasive CM (cutaneous melanoma) would be invaluable,” Dr. Rhodes writes. “In practice, SLNB is being used worldwide for this purpose.”

To better understand the predictive value of SLNB for patients with primary, invasive cutaneous melanoma with no clinically apparent lymphatic spread, Dr. Rhodes performed a Bayesian analysis of all informative studies including at least 50 patients to test the sensitivity and specificity of SLNB result for melanoma-related death.

Two reports included patients with tumors of intermediate thickness (1 to 4 millimeters). The risk of death due to melanoma for node-positive cases ranged from 26.2% to 31.6% in these patients, and 9.7% to 15.6% for node-negative cases.

The four reports including information on patients who had tumors measuring less than 1 millimeter thick found the same risk of death with node-positive and node-negative patients, ranging from 0% to 0.6%. One report included patients with tumors at least 4 millimeters thick, and found 32.5% of node-positive cases and 30.1% of node-negative cases died.

A separate analysis of 19 series of patients with any tumor thickness found the risk of melanoma-related death was 0% to 47.8% for node-positive patients and 0% to 13.3% for node-negative cases.

There is no current evidence that the procedure, or TLND for positive nodes, will improve disease-specific or overall survival, according to Dr. Rhodes. “If SLNB is being offered to obtain prognostic information, patients need to be informed how SLNB status will be used to predict cutaneous melanoma -related mortality and guide treatment options,” he concludes.

Arch Dermatol. Posted online December 20, 2010.

Reuters Health Information © 2011

Prognostic Usefulness of Sentinel Lymph Node Biopsy for Patients Who Have Clinically Node Negative, Localized, Primary Invasive Cutaneous Melanoma
A Bayesian Analysis Using Informative Published Reports

Arthur R. Rhodes, MD, MPH
Arch Dermatol. Published online December 20, 2010. doi:10.1001/archdermatol.2010.371

Objective To assess the prognostic value of sentinel lymph node biopsy status for patients with localized, clinically node negative, primary invasive cutaneous melanoma.

Design Predictive value of positive or negative sentinel lymph node biopsy (SLNB) results for melanoma-related death, using raw numbers from informative publications.

Setting and Participants Reports comprising 50 patients with cutaneous melanoma who had undergone SLNB, based on PubMed search (January 1, 1993, through June 3, 2010).

Main Outcome Measure Melanoma-related death.

Results. For the 2 informative reports of patients with tumors of intermediate thickness (1-4 mm), risk of melanoma-related death ranged from 26.2% to 31.6% for node-positive cases and from 9.7% to 15.6% for node-negative cases. Based on 4 informative reports of patients with thin tumors (1 mm), risk of melanoma-related death ranged from 0% to 0.6% for both node-positive and node-negative cases. For the single informative report of patients with thick tumors (4 mm), risk of melanoma-related death was 32.5% for node-positive cases and 30.1% for node-negative cases. For 19 informative case series with any tumor thickness, risk of melanoma-related death ranged from 0% to 47.8% for node-positive cases and from 0% to 13.3% for node-negative cases.

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January 19, 2011. Tags: , , , , , , . Health. Leave a comment.