Thick Melanoma: Prognostic Value of Positive Sentinel Nodes

Background Sentinel lymph node biopsy (SNB) is a widely accepted procedure used to accurately stage patients with melanoma. Its value in patients with thick melanoma (Breslow thickness >4 mm) is reason for discussion because of the generally poor prognosis of these patients. The purpose of this study was to report on the incidence of SNB positivity in patients with thick melanoma and to analyze the prognostic value of SNB in these patients. Methods The prospective database of 248 patients with cutaneous melanoma, who underwent SNB in the Maaslandhospital Sittard between January 1994 and August 2007, was reviewed and completed. In 31 patients, SNB was performed for a thick melanoma. We analyzed survival (Kaplan-Meier) and survival differences (log-rank) in this group. Results In 64.5% of the patients with a thick melanoma, the SNB was positive. In our patients, SNB result was the only predictor for overall survival in patients with a thick melanoma (P = 0.045). Conclusions To be accurately informed about a patient's prognosis and to decide whether subsequent completion lymph node dissection is indicated, SNB should not be omitted in patients with a primary thick melanoma.