Time to Sentinel Node Biopsy Did Not Affect Melanoma Survival

Waiting as long as 3 months from a melanoma diagnosis to sentinel lymph node biopsy had no effect on 5-year survival or sentinel node positivity rate, according to the results of a study published in European Journal of Cancer.

According to the study by Charlotte M. C. Oude Ophuis, of Erasmus MC Cancer Institute, Rotterdam, Netherlands, and colleagues most melanoma guidelines recommend wide local excision and sentinel node biopsy as soon as possible after diagnosis.

“Whether intervals longer than 3 months may have an effect cannot be determined by this study,” the researchers wrote. “This reassuring information supports the removal of strict time intervals for wide local excision and sentinel node biopsy from melanoma guidelines and can be used in daily clinical practice to counsel patients and reduce the number of high urgency referrals.”

With this study, Oude Ophuis and colleagues examined if time interval between diagnosis and sentinel node biopsy had any effect on sentinel node positivity and patient survival. They conducted a retrospective observational study of 3,546 patients with melanoma who underwent sentinel node biopsy from the EORTC Melanoma Group from 1997 to 2013. Patients were included only if biopsy was performed within 180 days of diagnosis.

The median time from diagnosis to biopsy was 43 days. The researchers found that there was significant variation of time from diagnosis to biopsy between centers, ranging from 25 to 58 days.

Positive sentinel nodes were identified in 19.9% of patients.

“Younger age, head and neck melanomas, higher Breslow thickness, ulceration, high Clark level, and a higher number of sentinel nodes removed were found to be predictors for a positive sentinel node, which is in line with previous reports,” the researchers wrote.

Sentinel node positivity was equal for early surgery (43 days or less) compared with late surgery. In addition, the estimated 5-year disease-free and melanoma-specific survival rates were not significantly different for patients who underwent early compared with late surgery.

With a median follow-up of 50 months, time interval from diagnosis to sentinel node biopsy was not associated with worse melanoma-specific survival or disease-free survival. However, worse outcomes were associated with sentinel node metastasis (hazard ratio [HR], 3.17 [95% CI, 2.53–3.97]), ulceration (HR, 1.99 [95% CI, 1.58–2.51]), Breslow thickness (HR, 1.06 [95% CI, 1.04–1.08]), and male gender (HR, 1.58 [95% CI, 1.26–1.98]; P < .00001 for all).

“The sentinel node biopsy time intervals in the current study ranged between 4 and 180 days, with 50% of patients being operated between 29 and 60 days (interquartile range), and the variance of time interval is low between centers,” the researchers wrote. “This small range limits the possibility to study effects of a wider time interval; no conclusions can be drawn on a time interval beyond the maximum range.”