Sentinel lymph node status and oncological outcomes of high-risk and low-risk cutaneous primary melanoma
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Introduction:
The role of sentinel lymph node biopsy (SLNB) in clinically node-negative melanoma has been questioned in the era of effective adjuvant immunotherapy. We evaluated the staging and prognostic value of SLNB in a single-centre cohort, with emphasis on patients with “high-risk” primary tumours.
Methods:
We retrospectively analysed 300 consecutive patients with cutaneous melanoma who underwent wide local excision with SLNB at a tertiary melanoma centre (April 2018–April 2023). Patients were stratified by AJCC 8th edition T stage into low-risk (T1–T3a) and high-risk (T3b–T4b) groups. Outcomes included SLN positivity, recurrence, and disease-free survival (DFS). DFS was assessed using Kaplan–Meier methods with log-rank testing; restricted mean survival time (RMST) was calculated to 3 years. In high-risk patients with available data, the Melanoma Institute of Australia (MIA) sentinel node risk tool was evaluated for discrimination and calibration.
Results:
Median age was 60.7 years and 51.3% were female. Overall SLN positivity was 22.0% (66/300) and was higher in high-risk than low-risk melanoma (31.5% [28/89] vs 18.0% [38/211], P=0.009). Recurrence occurred in 16.0% (48/300), more frequently in high-risk patients (31.5% vs 9.5%). Estimated DFS at 1 and 3 years was 96.6% and 81.8% for low-risk melanoma versus 87.9% and 68.6% for high-risk melanoma (log-rank P<0.001); RMST to 3 years favoured the low-risk group by 115.9 days (95% CI 20.8–213.3). SLNB resulted in substantial stage migration in high-risk clinically node-negative patients, identifying pathological stage IIIC disease in 31.5% (28/89) who would otherwise be classified as stage IIB/IIC.
Conclusion:
SLNB continues to provide clinically important staging and prognostic information, particularly in high-risk clinically node-negative melanoma where occult nodal disease is common. Omitting SLNB risks systematic understaging and loss of prognostic resolution.
The role of sentinel lymph node biopsy (SLNB) in clinically node-negative melanoma has been questioned in the era of effective adjuvant immunotherapy. We evaluated the staging and prognostic value of SLNB in a single-centre cohort, with emphasis on patients with “high-risk” primary tumours.
Methods:
We retrospectively analysed 300 consecutive patients with cutaneous melanoma who underwent wide local excision with SLNB at a tertiary melanoma centre (April 2018–April 2023). Patients were stratified by AJCC 8th edition T stage into low-risk (T1–T3a) and high-risk (T3b–T4b) groups. Outcomes included SLN positivity, recurrence, and disease-free survival (DFS). DFS was assessed using Kaplan–Meier methods with log-rank testing; restricted mean survival time (RMST) was calculated to 3 years. In high-risk patients with available data, the Melanoma Institute of Australia (MIA) sentinel node risk tool was evaluated for discrimination and calibration.
Results:
Median age was 60.7 years and 51.3% were female. Overall SLN positivity was 22.0% (66/300) and was higher in high-risk than low-risk melanoma (31.5% [28/89] vs 18.0% [38/211], P=0.009). Recurrence occurred in 16.0% (48/300), more frequently in high-risk patients (31.5% vs 9.5%). Estimated DFS at 1 and 3 years was 96.6% and 81.8% for low-risk melanoma versus 87.9% and 68.6% for high-risk melanoma (log-rank P<0.001); RMST to 3 years favoured the low-risk group by 115.9 days (95% CI 20.8–213.3). SLNB resulted in substantial stage migration in high-risk clinically node-negative patients, identifying pathological stage IIIC disease in 31.5% (28/89) who would otherwise be classified as stage IIB/IIC.
Conclusion:
SLNB continues to provide clinically important staging and prognostic information, particularly in high-risk clinically node-negative melanoma where occult nodal disease is common. Omitting SLNB risks systematic understaging and loss of prognostic resolution.
Date Acceptance
2026-03-04
Citation
World Journal of Surgical Oncology
ISSN
1477-7819
Publisher
BMC
Journal / Book Title
World Journal of Surgical Oncology
Copyright Statement
Copyright This paper is embargoed until publication. Once published the Version of Record (VoR) will be available on immediate open access.
License URL
Publication Status
Accepted