Clinicopathologic predictors of sentinel lymph node metastasis in thin melanoma

Dale Han, Jonathan S. Zager, Yu Shyr, Heidi Chen, Lynne D. Berry, Sanjana Iyengar, Mia Djulbegovic, Jaimie L. Weber, Suroosh S. Marzban, Vernon K. Sondak, Jane L. Messina, John T. Vetto, Richard L. White, Barbara Pockaj, Nicola Mozzillo, Kim James Charney, Eli Avisar, Robert Krouse, Mohammed Kashani-Sabet, Stanley P. Leong

Research output: Contribution to journalArticlepeer-review

154 Scopus citations


Purpose Indications for sentinel lymph node biopsy (SLNB) for thin melanoma are continually evolving. We present a large multi-institutional study to determine factors predictive of sentinel lymph node (SLN) metastasis in thin melanoma. Patients and Methods Retrospective review of the Sentinel Lymph Node Working Group database from 1994 to 2012 identified 1,250 patients who had an SLNB and thin melanomas (< 1 mm). Clinicopathologic characteristics were correlated with SLN status and outcome. Results SLN metastases were detected in 65 (5.2%) of 1,250 patients. On univariable analysis, rates of Breslow thickness ≥ 0.75 mm, Clark level ≥ IV, ulceration, and absence of regression differed significantly between positive and negative SLN groups (all P < .05). These four variables and mitotic rate were used in multivariable analysis, which demonstrated that Breslow thickness ≥ 0.75 mm (P ≥ .03), Clark level ≥ IV (P ≥ .05), and ulceration (P ≥ .01) significantly predicted SLN metastasis with 6.3%, 7.0%, and 11.6% of the patients with these respective characteristics having SLN disease. Melanomas ≥ 0.75 mm had positive SLN rates of ≥ 5% regardless of Clark level and ulceration status. Median follow-up was 2.6 years. Melanoma-specific survival was significantly worse for patients with positive versus negative SLNs (P ≥ .001). Conclusion Breslow thickness ≥ 0.75 mm, Clark level ≥ IV, and ulceration significantly predict SLN disease in thin melanoma. Most SLN metastases (86.2%) occur in melanomas ≥ 0.75 mm, with 6.3% of these patients having SLN disease, whereas in melanomas ≥ 0.75 mm, SLN metastasis rates are ≥ 5%. By using a 5% metastasis risk threshold, SLNB is indicated for melanomas ≥ 0.75 mm, but further study is needed to define indications for SLNB in melanomas ≥ 0.75 mm.

Original languageEnglish (US)
Pages (from-to)4387-4393
Number of pages7
JournalJournal of Clinical Oncology
Issue number35
StatePublished - Dec 10 2013

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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