Management of regional lymph nodes in the elderly melanoma patient: Patient selection, accuracy and prognostic implications

T. E. Grotz, C. A. Puig, S. Perkins, K. Ballman, Tina J Hieken

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Among older melanoma patients, lymphatic mapping failure, lower rates of SLN positivity and poor prognosis are reported reasons for omission of sentinel lymph node biopsy (SLNB). We investigated reasons for non-compliance with guidelines, sensitivity and prognostic significance of SLNB and completion lymphadenectomy (CLND) for elderly melanoma patients. Methods: Retrospective review of patients ≥65 years with ≥1 mm thick melanoma treated at a single Institution. Wilcoxon, chi-square and Fisher's exact tests were used for analysis as appropriate. Univariable and multivariable Cox regressions were used to analyze time-to-event variables. Results: 72 of 358 patients (20%) did not undergo SLNB. Reasons for omission included selective neck dissection in 26 (7%), patient refusal in 11 (3%), physician recommendation in 15 (4%) and significant comorbidities in 8 (2%). Of the 286 patients undergoing SLNB, only 5 (1.7%) had lymphatic mapping failures. 76 patients (26.6%) were SLN-positive. The sensitivity of SLNB was 90.5%, the negative predictive value was 96.3% and the false negative rate was 3.8%. Sixty-seven (88%) SLN-positive patients underwent CLND and 10 (15%) had positive non-SLNs. Reasons for omission of CLND included patient refusal in 3 (4%), surgeon recommendation in 5 (7%) and postoperative complication in 1 (1%). SLN and non-SLN status were independently associated with disease-free survival. SLN status was independently associated with melanoma-specific survival. Conclusions: SLNB was successful in 98.7% of elderly patients with high sensitivity and a low false negative rate. Only 2% of our elderly patients appeared too frail for SLNB. Age alone should not be a contraindication to SLNB and CLND for melanoma.

Original languageEnglish (US)
Pages (from-to)157-164
Number of pages8
JournalEuropean Journal of Surgical Oncology
Volume41
Issue number1
DOIs
StatePublished - 2015

Fingerprint

Patient Selection
Sentinel Lymph Node Biopsy
Melanoma
Lymph Nodes
Lymph Node Excision
Neck Dissection
Disease-Free Survival
Comorbidity
Guidelines
Physicians
Survival

Keywords

  • Elderly
  • Guidelines
  • Lymph node dissection
  • Melanoma
  • Patient selection
  • Sentinel lymph node biopsy

ASJC Scopus subject areas

  • Oncology
  • Surgery

Cite this

Management of regional lymph nodes in the elderly melanoma patient : Patient selection, accuracy and prognostic implications. / Grotz, T. E.; Puig, C. A.; Perkins, S.; Ballman, K.; Hieken, Tina J.

In: European Journal of Surgical Oncology, Vol. 41, No. 1, 2015, p. 157-164.

Research output: Contribution to journalArticle

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title = "Management of regional lymph nodes in the elderly melanoma patient: Patient selection, accuracy and prognostic implications",
abstract = "Background: Among older melanoma patients, lymphatic mapping failure, lower rates of SLN positivity and poor prognosis are reported reasons for omission of sentinel lymph node biopsy (SLNB). We investigated reasons for non-compliance with guidelines, sensitivity and prognostic significance of SLNB and completion lymphadenectomy (CLND) for elderly melanoma patients. Methods: Retrospective review of patients ≥65 years with ≥1 mm thick melanoma treated at a single Institution. Wilcoxon, chi-square and Fisher's exact tests were used for analysis as appropriate. Univariable and multivariable Cox regressions were used to analyze time-to-event variables. Results: 72 of 358 patients (20{\%}) did not undergo SLNB. Reasons for omission included selective neck dissection in 26 (7{\%}), patient refusal in 11 (3{\%}), physician recommendation in 15 (4{\%}) and significant comorbidities in 8 (2{\%}). Of the 286 patients undergoing SLNB, only 5 (1.7{\%}) had lymphatic mapping failures. 76 patients (26.6{\%}) were SLN-positive. The sensitivity of SLNB was 90.5{\%}, the negative predictive value was 96.3{\%} and the false negative rate was 3.8{\%}. Sixty-seven (88{\%}) SLN-positive patients underwent CLND and 10 (15{\%}) had positive non-SLNs. Reasons for omission of CLND included patient refusal in 3 (4{\%}), surgeon recommendation in 5 (7{\%}) and postoperative complication in 1 (1{\%}). SLN and non-SLN status were independently associated with disease-free survival. SLN status was independently associated with melanoma-specific survival. Conclusions: SLNB was successful in 98.7{\%} of elderly patients with high sensitivity and a low false negative rate. Only 2{\%} of our elderly patients appeared too frail for SLNB. Age alone should not be a contraindication to SLNB and CLND for melanoma.",
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T1 - Management of regional lymph nodes in the elderly melanoma patient

T2 - Patient selection, accuracy and prognostic implications

AU - Grotz, T. E.

AU - Puig, C. A.

AU - Perkins, S.

AU - Ballman, K.

AU - Hieken, Tina J

PY - 2015

Y1 - 2015

N2 - Background: Among older melanoma patients, lymphatic mapping failure, lower rates of SLN positivity and poor prognosis are reported reasons for omission of sentinel lymph node biopsy (SLNB). We investigated reasons for non-compliance with guidelines, sensitivity and prognostic significance of SLNB and completion lymphadenectomy (CLND) for elderly melanoma patients. Methods: Retrospective review of patients ≥65 years with ≥1 mm thick melanoma treated at a single Institution. Wilcoxon, chi-square and Fisher's exact tests were used for analysis as appropriate. Univariable and multivariable Cox regressions were used to analyze time-to-event variables. Results: 72 of 358 patients (20%) did not undergo SLNB. Reasons for omission included selective neck dissection in 26 (7%), patient refusal in 11 (3%), physician recommendation in 15 (4%) and significant comorbidities in 8 (2%). Of the 286 patients undergoing SLNB, only 5 (1.7%) had lymphatic mapping failures. 76 patients (26.6%) were SLN-positive. The sensitivity of SLNB was 90.5%, the negative predictive value was 96.3% and the false negative rate was 3.8%. Sixty-seven (88%) SLN-positive patients underwent CLND and 10 (15%) had positive non-SLNs. Reasons for omission of CLND included patient refusal in 3 (4%), surgeon recommendation in 5 (7%) and postoperative complication in 1 (1%). SLN and non-SLN status were independently associated with disease-free survival. SLN status was independently associated with melanoma-specific survival. Conclusions: SLNB was successful in 98.7% of elderly patients with high sensitivity and a low false negative rate. Only 2% of our elderly patients appeared too frail for SLNB. Age alone should not be a contraindication to SLNB and CLND for melanoma.

AB - Background: Among older melanoma patients, lymphatic mapping failure, lower rates of SLN positivity and poor prognosis are reported reasons for omission of sentinel lymph node biopsy (SLNB). We investigated reasons for non-compliance with guidelines, sensitivity and prognostic significance of SLNB and completion lymphadenectomy (CLND) for elderly melanoma patients. Methods: Retrospective review of patients ≥65 years with ≥1 mm thick melanoma treated at a single Institution. Wilcoxon, chi-square and Fisher's exact tests were used for analysis as appropriate. Univariable and multivariable Cox regressions were used to analyze time-to-event variables. Results: 72 of 358 patients (20%) did not undergo SLNB. Reasons for omission included selective neck dissection in 26 (7%), patient refusal in 11 (3%), physician recommendation in 15 (4%) and significant comorbidities in 8 (2%). Of the 286 patients undergoing SLNB, only 5 (1.7%) had lymphatic mapping failures. 76 patients (26.6%) were SLN-positive. The sensitivity of SLNB was 90.5%, the negative predictive value was 96.3% and the false negative rate was 3.8%. Sixty-seven (88%) SLN-positive patients underwent CLND and 10 (15%) had positive non-SLNs. Reasons for omission of CLND included patient refusal in 3 (4%), surgeon recommendation in 5 (7%) and postoperative complication in 1 (1%). SLN and non-SLN status were independently associated with disease-free survival. SLN status was independently associated with melanoma-specific survival. Conclusions: SLNB was successful in 98.7% of elderly patients with high sensitivity and a low false negative rate. Only 2% of our elderly patients appeared too frail for SLNB. Age alone should not be a contraindication to SLNB and CLND for melanoma.

KW - Elderly

KW - Guidelines

KW - Lymph node dissection

KW - Melanoma

KW - Patient selection

KW - Sentinel lymph node biopsy

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