The aim of this study was to evaluate the advantages and disadvantages of sentinel lymph node biopsy (SLNB) in patients with cutaneous melanoma.
Descriptive follow-up study.
In the period 1995-2004, 300 patients with cutaneous melanoma (Breslow thickness: ≥ 1.0 mm) underwent SLNB and, in case of a tumour-positive result, regional lymph node dissection. Results of the SLNB procedure, postoperative complications, follow-up, recurrences, disease-free survival and disease-specific survival were evaluated.
The SLNB detection rate was 99. 85 patients had a tumour-positive SLNB (28) and underwent completion regional lymph node dissection; 215 patients underwent SLNB alone. The rate of postoperative complications after SLNB was 7. With a median follow up of 51 months, the false-negative rate was 11. The recurrence rate was 23 (SLNB negative: 19; SLNB positive 34; p = 0.005). In-transit metastases were found in 4 of the SLNB-negative group and in 20 of the SLNB-positive group (p < 0.001). The 5-year disease-free survival and disease-specific survival rates were 79 and 86, respectively, in SLNB-negative patients and 57 and 71, respectively, in SLNB-positive patients. Multivariate analysis showed that the independent prognostic factors for disease-free survival were presence of ulceration (p < 0.001) and SLNB positivity (p < 0.01). Prognostic factors for overall survival were presence of ulceration (p < 0.001) and male sex (p < 0.05), but not the SLNB results. Multivariate analysis also showed that SLNB positivity (p < 0.001) and presence of ulceration (p < 0.01) were independent prognostic factors for developing in-transit metastases.
SLNB in patients with cutaneous melanoma is still only of prognostic value since survival benefit is not proven. Disadvantages of SLNB were the false-negative rate, the possibility of an increased risk of in-transit metastases in SLNB-positive patients, and postoperative complications. These must be kept in mind when offering patients SLNB.
Ned Tijdschr Geneeskd 2005;149:1845-51