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Patient age associated with lymph node positivity in thin melanomas

Patient age was a factor in regional lymph node positivity in clinically localized melanomas 0.5 mm to 10 mm, according to recently published study results in JAMA Dermatology.

Andrew J. Sinnamon, MD, of the surgery department, Hospital of the University of Pennsylvania, Philadelphia, and colleagues used the National Cancer Database to conduct a retrospective cohort study of patients from more than 1,500 hospitals in the U.S. between 2010 and 2013. Analysis was conducted between Oct. 1, 2016, and Jan. 15, 2017.

There were 8,722 patients (median age, 56 years; 53.4% male) with clinical stage melanoma 0.5 mm to 1.0 mm undergoing curative resection with regional nodal evaluation included in the study.

There were 333 patients with nodal metastases with an overall positivity rate of 3.8% (95% CI, 3.4-4.2).

Patients with negative lymph nodes had a median age of 56 years, and patients with positive lymph nodes had a median age of 52 years (P < .001).

Lymph node positivity was associated with younger age, female sex, thickness of 0.76 mm or larger, increasing Clark level, mitoses, ulceration and lymphovasular invasion, according to multivariable analysis.

A classification tree analysis found that mitoses presence, Breslow thickness 0.76 mm or more and patient age were risk factors for lymph node metastases.

The lymph node positivity rate was 5.6% (95% CI, 3.3-8.6) among patients aged younger than 40 who had category T1b tumors 0.5 mm to 0.75 mm; this group is not generally recommended for sentinel lymph node biopsy, according to the researchers. However, among patients aged 65 and older who had T1b tumors 0.76 mm or larger, a group who would be recommended for sentinel lymph node biopsy, had a positivity rate of 3.9% (95% CI, 2.7-5.3).

“Consideration of [sentinel lymph node biopsy] should be given for patients younger than 40 years with T1b tumors 0.5 mm to 0.75 mm,” the researchers concluded. “Conversely, guidelines may be overly permissive in older patients with tumors 0.76 mm or larger. Consideration of patient age may allow more appropriate allocation of [sentinel lymph node biopsy], thus reducing both health care costs and possible unnecessary patient morbidity.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.