The North Pacific Surgical Association| Volume 199, ISSUE 5, P663-668, May 2010

Sentinel lymph node staging of cutaneous melanoma: predictors and outcomes



      The authors updated their experience with sentinel lymph node (SLN) biopsy of clinically node negative (N0) melanoma to clarify indications, predictive factors, and outcomes.


      A review of patients from the authors' institution's prospective database (n = 397) was performed; survival statistics were obtained from the institutional tumor registry.


      The SLN-positive (SLN+) rate was 16% (47 of 282) for lesions >1 mm thick; only 2 of 105 T1 lesions were SLN+. Thickness >2 mm, upper extremity primary, and ulceration predicted SLN+ status. Most SLN+ patients underwent completion node dissection; 12% had additional positive nodes. The false-negative SLN biopsy rate was 4.0%; the majority involved lower extremity and head and neck primaries. The overall complication rate was 26%; all were minor and resolved within 6 months. Overall 5-year survival rates were 73% and 92% for SLN+ and SLN-negative patients, respectively. SLN status was the most significant predictor of survival.


      SLN status, the most important determinant of outcome for clinically N0 melanoma, correlated with T stage, ulceration, and site. Staging of T1 lesions had low yield. A minority of completion node dissections yielded additional positive nodes.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Linos E.
        • Swetter S.M.
        • Cockburn M.G.
        Increasing burden of melanoma in the United States.
        J Invest Dermatol. 2009; 129: 1666-1674
        • Geller A.
        • Miller D.
        • Annas G.
        Melanoma incidence and mortality among US whites, 1969-1999.
        JAMA. 2002; 288: 1719-1720
        • Purdue M.P.
        • Freeman L.E.
        • Anderson W.F.
        Recent trends in incidence of cutaneous melanoma among US Caucasian young adults.
        J Invest Dermatol. 2008; 128: 2905-2908
        • National Cancer Institute
        SEER stat fact sheets: melanoma of the skin.
        (Accessed March 5, 2010)
        • Horner M.
        • Ries L.
        • Krapcho M.
        • et al.
        SEER cancer statistics review, 1975-2006.
        • Morton D.
        • Thompson J.
        • Cochran A.
        • et al.
        Sentinel-node biopsy or nodal observation in melanoma.
        New Engl J Med. 2006; 355: 1307-1317
        • Gershenwald J.E.
        • Thompson W.
        • et al.
        Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients.
        J Clin Oncol. 1999; 17: 976-983
        • Testori A.
        • Rutkowski P.
        • Marsden J.
        • et al.
        Surgery and radiotherapy in the treatment of cutaneous melanoma.
        Ann Oncol. 2009; 20: vi22-vi29
        • Wong S.L.
        • Brady M.S.
        • Busam K.J.
        Results of sentinel lymph node biopsy in patients with thin melanoma.
        Ann Surg Oncol. 2006; 13: 302-309
        • Emery R.E.
        • Stevens J.S.
        • Nance R.W.
        Sentinel node staging of primary melanoma by the “10% rule”: pathology and clinical outcomes.
        Am J Surg. 2007; 193: 618-622
        • Morris K.T.
        • Stevens J.S.
        • Pommier R.F.
        Usefulness of preoperative lymphoscintigraphy for the identification of sentinel lymph nodes in melanoma.
        Am J Surg. 2001; 181: 423-426
        • Cochran A.
        • Balda B.
        • Starz H.
        • et al.
        The Augsburg Consensus: techniques of lymphatic mapping, sentinel lymphadenectomy, and completion lymphadenectomy in cutaneous malignancies.
        Cancer. 2000; 89: 236-241
        • Vetto J.T.
        • Pommier R.F.
        • Schmidt W.A.
        Diagnosis of palpable breast lesions in younger women by the modified triple test is accurate and cost-effective.
        Arch Surg. 1996; 131: 967-972
        • Zogakis T.
        • Essner R.
        • Wang H.
        Melanoma recurrence patterns after negative sentinel lymphadenectomy.
        Arch Surg. 2005; 140: 865-872
        • Morton D.L.
        • Cochran A.J.
        • Thompson J.F.
        • et al.
        Sentinel node biopsy for early-stage melanoma.
        Ann Surg. 2005; 242: 302-311
        • Leong S.P.
        • Accortt N.A.
        • Essner R.
        • et al.
        Impact of sentinel node status and other risk factors on the clinical outcome of head and neck melanoma patients.
        Arch Otolaryngol Head Neck Surg. 2006; 132: 370-373
        • Warycha Ma
        • Zakrzewski J.
        • Ni Q.
        • et al.
        Meta-analysis of sentinel lymph node positivity in thin melanoma.
        Cancer. 2009; 115: 869-879
        • Jakub J.W.
        • Huebner M.
        • Shivers S.
        • et al.
        The number of lymph nodes involved with metastatic disease does not affect outcome in melanoma patients as long as all disease is confined to the sentinel lymph node.
        Ann Surg Oncol. 2009; 16: 2245-2251
        • Caracò C.
        • Marone U.
        • Celentano E.
        Impact of false-negative sentinel lymph node biopsy on survival in patients with cutaneous melanoma.
        Ann Surg Oncol. 2007; 14: 2662-2667
        • de Vries M.
        • Hoekstra H.J.
        • Hoekstra-Weebers J.E.
        Quality of life after axillary or groin sentinel lymph node biopsy, with or without completion lymph node dissection, in patients with cutaneous melanoma.
        Ann Surg Oncol. 2009; 16: 2840-2847