ASO Author Reflection: Sentinel Lymph Node Biopsy in Thin Melanoma
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ASO AUTHOR REFLECTIONS
ASO Author Reflection: Sentinel Lymph Node Biopsy in Thin Melanoma Andrew J. Sinnamon, MD, MSCE1,2, Phyllis A. Gimotty, PhD2, Giorgos C. Karakousis, MD1, and Yu-Xiao Yang, MD, MSCE2 1
Division of Surgical Oncology, Department of Surgery, University of Pennsylvania, Philadelphia, PA; 2Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
PAST Sentinel lymph node biopsy (SLNB) is a commonly accepted staging modality for melanoma to detect the presence of occult regional nodal metastases. The possibility of a therapeutic effect of SLNB was explored in the Multicenter Selective Lymphadenectomy Trial (MSLT1); no difference in survival was found among those who were randomized to undergo SLNB compared with those who underwent observation of the nodal basin.1 The trial report of MSLT1 did not include patients with tumors \ 1.2 mm in thickness, an important point when considering that 70% of patients present with T1 disease.2 In the absence of such prospective data, we used the National Cancer Data Base to perform a propensity-matched analysis to assess the impact of lymph node biopsy (LNB, a surrogate marker for SLNB) on overall survival (OS) among patients with T1 melanoma (0.5–1.0 mm).3 PRESENT The propensity-matched analysis included 15,194 patients; 8524 patients had tumors 0.5–0.7 mm in thickness and 6670 patients had tumors 0.8–1.0 mm. Patients undergoing LNB were matched 1:1 to patients who did not
undergo LNB. The cohorts were well-balanced on patient, tumor, and hospital factors. For patients with tumors 0.5–0.7 mm, we found no difference in OS between those who underwent LNB and those who did not. However, among patients with thicker tumors 0.8–1.0 mm, OS was longer for those who underwent LNB compared with those who did not, by a difference of 3.6% at 5 years. While this is a small clinical difference, it is consistent with what may be anticipated given the rate of SLN positivity in this subgroup of patients. FUTURE These results support the continued use of SLNB among patients with tumors at least 0.8 mm in thickness, as current societal and NCCN guidelines recommend.4,5 Further prospective study is important to validate these findings.
FUNDING PA Gimotty was supported in part by a grant from the Specialized Programs of Research Excellence (SPORE), P50CA174523. DISCLOSURES
There are no financial conflicts to disclose.
ETHICAL APPROVAL The source study was reviewed and approved by the Institutional Review Board at the University of Pennsylvania (Protocol 828019).
REFERENCES
Ó Society of Surgical Oncology 2020 First Received: 26 July 2020 Accepted: 9 August 2020 A. J. Sinnamon, MD, MSCE e-mail: [email protected]
1. Morton DL, Thompson JF, Cochran AJ, et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med. 2014;370(7):599–609. 2. Landow SM, Gjelsvik A, Weinstock MA. Mortality burden and prognosis of thin melanomas overall and by subcategory of thickness, SEER regis
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