Is sentinel lymph node biopsy of therapeutic relevance for melanoma?

Introduction: It is still unclear whether sentinel lymph node biopsy (SLNB) has an effect on the survival or recurrence-free survival of patients. It would be necessary to draw comparisons between patients with SLNB ( or with selective lymph node dissection in the case of positive SLNB) and patients without SLNB who underwent only close clinical and sonographic follow-up. To date no results from prospective, randomized studies of SLNB are available. Material and Methods: Patients with SLNB (n = 283) and patients in clinical stage I and II with close follow-up examinations only ( n = 3,514) were studied retrospectively in this investigation with regard to prognostic factors established in the literature: sex, age, tumor thickness, histological tumor type, ulceration and localization. Results: Multivariate analysis showed an independent significant advantage with regard to survival when SLNB had been performed (p = 0.017). Compared with patients in clinical stage I and II with close follow-up only ( n = 2,617), patients in stage I with negative SLNB ( n = 238) had a significantly lower melanoma-related mortality (p = 0.0042) and, especially, fewer recurrences in the regional lymph node station area ( p = 0.0026). With regard to survival without distant metastases, patients with positive SLNB ( n = 33) did not significantly benefit by comparison with patients who developed lymph node metastasis identified clinically or sonographically later during follow-up examinations ( n = 246; p = 0.0084). Conclusion: In the relatively short follow-up period after SLNB, patients for whom SLNB had been performed had on the whole a prognostic advantage over patients who were subject only to close follow-up monitoring. Patients for whom subclinical lymph node metastases had been removed as the result of a positive SLNB did not have a better prognosis than patients without SLNB who had developed lymph node metastases within the follow-up period. Copyright (C) 2004 S. Karger AG, Basel.