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SLNB used in patients with thin melanomas prior to guidelines

Issue: May 25, 2015

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NEW YORK — Sentinel lymph node biopsy was used in patients with thin melanomas who did not have high-risk features and who had a very low risk for sentinel lymph node positivity prior to guidelines recommending against its use in this setting, according to observational study results presented at the HemOnc Today Melanoma and Cutaneous Malignancies meeting.

Little evidence exists to support the routine use of sentinel lymph node biopsy (SLNB) in patients with T1 melanomas — or thin melanomas with Breslow’s depth less than 1 mm— according to guidelines published by ASCO and the Society of Surgical Oncology (SSO) in 2013. However, SLNB may be utilized in high-risk cases of thin melanomas, such as in patients who present with ulceration and/or a mitotic rate of at least 1/mm², according to study background.

Sekwon Jang, MD, of the Inova Comprehensive Cancer and Research Institute in Virginia, and colleagues sought to determine the frequency of use of SLNB in patients with thin melanomas who do not meet these high-risk criteria prior to the publication of the ASCO/SSO guidelines.

Researchers used the SEER database to identify 60,462 patients with stage T1a melanoma based on American Joint Committee on Cancer 6^th edition (2004-2009) and 7^th edition (2010-2011) criteria. Over half the patients (55%) were male and 93% were white. Thirty-seven percent of the population was aged 65 years or older.

A majority of the patients (80%) were diagnosed with melanoma between 2004 and 2009.

Overall, 9% (n = 5,413) of the patient population underwent SLNB with or without lymph node dissection.

Biopsy utilization rates were significantly lower in 2010 and 2011 compared with rates from 2004 to 2009 (8.3% vs. 9.1%; P < .01). A majority of patients (96.6%) who underwent SLNB had negative sentinel lymph node results.

The researchers recommended further study to assess the impact of ASCO/SSO guidelines on the usage of SLNB in patients with thin melanomas after 2013. – by Cameron Kelsall

Reference:

Jang S, et al. Utilization of sentinel lymph node biopsy in patients with thin melanomas lacking high risk features (T1a) in the US population. Presented at: HemOnc Today Melanoma and Cutaneous Malignancies; April 10-11, 2015; New York.

Disclosure: Jang reports no relevant financial disclosures.