Stratifying SLN incidence in intermediate thickness melanoma patients

James M. Chang, Heidi E. Kosiorek, Amylou C. Dueck, Stanley P.L. Leong, John T. Vetto, Richard L. White, Eli Avisar, Vernon K. Sondak, Jane L. Messina, Jonathan S. Zager, Carlos Garberoglio, Mohammed Kashani-Sabet, Barbara A. Pockaj

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Background: Guidelines for melanoma recommend sentinel lymph node biopsy (SLNB) in patients with melanomas ≥1 mm thickness. Recent single institution studies have found tumors <1.5 mm a low-risk group for positive SLNB. Methods: A retrospective review of the Sentinel Lymph Node Working Group multicenter database identified patients with intermediate thickness melanoma (1.01–4.00 mm) who had SLNB, and assessed predictors for positive SLNB. Results: 3460 patients were analyzed, 584 (17%) had a positive SLNB. Univariate factors associated with a positive SLNB included age <60 (p <.001), tumor on the trunk/lower extremity (p <.001), Breslow depth ≥2 mm (p <.001), ulceration (p <.001), mitotic rate ≥1/mm2 (p =.01), and microsatellitosis (p <.001). Multivariate analysis revealed age, location, and Breslow depth as significant predictors. Patients ≥75 with lesions 1.01–1.49 mm on the head/neck/upper extremity and 1.5–1.99 mm without high-risk features had <5% risk of SLN positivity. Conclusions: Intermediate thickness melanoma has significant heterogeneity of SLNB positivity. Low-risk subgroups can be found among older patients in the absence of high-risk features.

Original languageEnglish (US)
Pages (from-to)699-706
Number of pages8
JournalAmerican journal of surgery
Issue number4
StatePublished - Apr 2018

ASJC Scopus subject areas

  • Surgery


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