Master of Science in Clinical Investigation
Quantitative Health Sciences
First Thesis Advisor
Robert Goldberg, PhD
Lymph Node Excision, Melanoma, Sentinel Lymph Node Biopsy, Aged, Outcome Assessment (Health Care)
Theses, UMMS; Lymph Node Excision; Melanoma; Sentinel Lymph Node Biopsy; Aged; Outcome Assessment (Health Care)
Background: A landmark study suggested that wide excision of intermediate-thickness melanoma with sentinel lymph node biopsy (SLNB) and subsequent completion lymph node dissection (CLND) for regional disease may improve prognostication and disease-free survival (DFS) compared with those undergoing wide excision alone. However, these benefits were relatively small and not associated with an improvement in disease-specific survival (DSS). It remains unknown if SLNB and subsequent treatments are beneficial in elderly patients who have a decreased overall (OS) due to other causes.
Methods: Adults ≥ 70 years of age, who underwent surgical intervention for intermediate-thickness cutaneous melanoma from 2000-2013 were identified from a prospectively-maintained database. Clinicopathologic variables measured included age, gender, anatomic site, histologic type, tumor thickness, ulceration, receipt and result of SLNB, completion of CLND, OS, and DFS.
Results: Ninety-one patients underwent excision of an intermediate-thickness melanoma. Forty-nine patients (54%) received a SLNB. Seven of these biopsies (14%) were positive, and five patients went on to receive CLND. Five-year OS was 41% in patients who did not receive SLNB and 52% in patients who did receive SLNB (p=0.11). DFS was similar between groups independent of receipt of SLNB.
Conclusion: Among elderly patients with intermediate-thickness melanoma, patients who received SLNB had similar 5-year OS and DFS compared with those who did not receive SLNB. Routine SLNB for intermediate-thickness melanoma patients may not significantly change outcomes for this age group, and clinical decision-making should consider individual patient comorbidities and goals of care.
Dinh, KH. Sentinel Lymph Node Biopsy in Elderly Patients with Intermediate Thickness Melanoma: A Masters Thesis. (2015). University of Massachusetts Medical School. GSBS Dissertations and Theses. Paper 778. DOI: 10.13028/M2BP4N. http://escholarship.umassmed.edu/gsbs_diss/778
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