This article is more than 5 years old. Information may no longer be current.
Delayed sentinel lymph node biopsy safe after melanoma diagnosis
Click Here to Manage Email Alerts
Postponement of sentinel lymph node biopsy more than 30 days after melanoma diagnosis did not have a negative effect on long-term survival, according to study results.
“When we talk to patients diagnosed with melanoma, the main rationale is to get the surgical procedure over and done with and get the information and resources they need so that they can move on,” Mark Faries, MD, FACS, co-director of the melanoma program at The Angeles Clinic and Research Institute, said in a press release. “People can be reassured that if they are in a situation where for one reason or another they need to wait to have an operation, that’s fine, too.”
Previous data indicated delay between melanoma diagnosis and sentinel lymph node biopsy (SLNB) may impact outcomes — adversely by allowing growth and dissemination of metastases, or beneficially by allowing development of antimelanoma immune response — among patients with melanoma. Because both scenarios are possible, any effect of delayed SLNB on survival had been uncertain.
“We often get questions from patients as to whether or not they need to rush to have their operation performed when they are diagnosed with melanoma,” Faries said. “So, the question of whether waiting hurts or helps has never been clearly answered.”
Faries and colleagues queried a large prospectively maintained database from their institution of 2,483 patients diagnosed with stage I or stage II cutaneous melanoma who received wide local excision and SLNB.
Researchers stratified patients based on early and delayed receipt of SLNB, for which they considered early SLNB as occurring before 30 days after cutaneous biopsy (median time to surgery, 21 days) and delayed as occurring 30 or more days after initial diagnosis (median time to surgery, 41 days).
Initial exploratory analysis showed 57.9% of patients underwent SLNB less than 30 days after diagnosis, 34.7% between 30 and 59 days, 4.8% between 60 and 89 days, and 2.6% 90 days or more from diagnosis.
In total, 17.4% of patients had positive sentinel lymph nodes; 37% of positive sentinel lymph nodes occurred in patients who received delayed SLNB.
Patients who underwent delayed SLNB tended to be older (56.3 years vs. 54.7 years; P = .02) and had lower frequency of sentinel lymph node positivity (15.1% vs. 19.1%; P = .01).
Median follow-up was 8 years.
After adjusting for variables such as sex and sentinel lymph node status, multivariate analysis showed early and delayed SLNB did not serve as independent predictors for DFS (HR = 0.98; 95% CI, 0.81-1.18) or melanoma-specific survival (HR = 1.05; 95% CI, 0.83-1.34).
Age, Breslow thickness and presence of ulceration independently predicted worse DFS and melanoma-specific survival (P < .001 for all).
A delay of less than 30 days appeared independently associated with a 33% increased risk for sentinel lymph node positivity (OR = 1.33; 95% CI, 1.05-1.67).
To validate the findings, researchers conducted identical analyses using an independent dataset of the sentinel lymph node biopsy group (n = 1,165) from the Multicenter Selective Lymphadenectomy Trial-1 (MSLT-1).
Among the subset of patients, 46.3% underwent delayed SLNB and 19% had positive sentinel lymph nodes (n = 221). Unlike the prior analysis, patients undergoing delayed SLNB in MSLT-1 more frequently had positive sentinel nodes than those undergoing early SLNB (22.8% vs. 15.6%; P = .002). Despite this difference, researchers observed no difference in DFS or melanoma-specific survival in the early vs. delayed groups.
“Up to 30% of patients diagnosed with melanoma will report clinically relevant psychological distress and issued related to prognosis and fear of death are often cited as sources for anxiety in these patients,” the researchers wrote. “Delays between time of diagnosis and definitive surgical management are often inevitable. However, based on the results of this study, patients can be reassured that if the procedure must be delayed, there is a margin of time during which the efficacy of the operation is unlikely to be diminished.” – by Melinda Stevens
Disclosure: One researcher reports paid consultant roles with Bristol-Myers Squibb, GlaxoSmithKline and Provectus. The other researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts