WASHINGTONNode-negative patients with intermediate-to-thick
melanomas who underwent node staging by sentinel lymph node (SLN) biopsy had a
significant survival advantage over those staged by elective lymph node
dissection (ELND) or clinical examination, said Sophie Dessureault, MD, of the
University of South Florida H. Lee Moffitt Cancer Center, Tampa. She spoke on
behalf of the AJCC (American Joint Committee on Cancer) Melanoma Staging
Speaking at the 54th Annual Cancer Symposium of the Society of
Surgical Oncology, Dr. Dessureault explained that earlier studies of SLN biopsy
with lymphatic mapping in melanoma had found that it gives better information
on regional node metastases. The current study investigated whether that
advantage translates into improved survival for patients with negative nodes,
while also saving them the morbidity of complete node dissection.
The AJCC melanoma staging database yielded 14,574 patients with
negative nodes by SLN biopsy, ELND, or clinical examination. Retrospective
analysis showed that, with a mean follow-up of 5 years, patients with melanomas
thicker than 1 mm who had undergone SLN biopsy had a significant survival
advantage over those staged by either ELND or clinical examination.
At 5 years, 90% of the SLN biopsy patients were alive, compared
with 77% of ELND patients and 70% of clinical examination patients. SLN’s
survival advantage persisted regardless of T stage or whether the tumor was
The SLN advantage may exist because the technique permits the
pathologist to "focus on one node" rather than examine a larger
number more superficially, Dr. Dessureault suggested. With ELND, pathologists
"consistently miss microdisease," she said.
Using SLN biopsy for staging would produce "more uniform
populations for arms in clinical trials," she added, and could also
identify candidates for adjuvant therapy.