Detection of sentinel lymph node metastasis in thick melanoma provides promising adjuvant treatment

Introduction: The importance of sentinel lymph node biopsy in the treatment of thick melanomas (Breslow>4 mm) has so far been debated in the literature. Nowadays, histological verification of regional lymph node involvement is a prerequisite for adjuvant therapy. At the same time, the criteria for the need for sentinel lymph node biopsy are not uniform in Hungary either, there are institutes where this procedure is not performed in the case of thick melanomas. Aim: We have consistently performed sentinel lymph node biopsies in the case of melanomas thicker than 4 mm over a five-year long period at the Department of Dermatology and Allergology of the University of Szeged in order to investigate the proportion of clinically occult regional lymph node metastases present in south-east Hungary. Method: Out of 1133 patients diagnosed with cutaneous melanoma between 2007 and 2011 in our department, patients with primary melanomas thicker than 4 mm were retrospectively evaluated based on demographic data, clinical and histological features of the primary tumor correlated with the sentinel lymph node status. Results: During the 5-year period, 116 patients were diagnosed with thick melanoma and underwent surgical excision. Sentinel lymph node biopsy was performed in the case of 78 patients, which was found to be histologically positive in 50 cases. The mean age of patients was 58 years. Conclusion: Annually 10 patients with thick melanoma are treated in our department whose regional lymph node metastasis is verified by sentinel lymph node biopsy. Based on our results and the data from the National Cancer Registry, the annual number of patients where adjuvant therapy would be necessary depending on sentinel lymph node positivity is estimated to be up to 100 in Hungary. Given the relatively young mean age of the patient population, the use of adjuvant target/immunotherapy may be more effective in increasing overall survival compared to when treatment is only initiated upon visceral metastases.