Impact of Time Between Diagnosis and SLNB on Outcomes in Cutaneous Melanoma

Abstract

BACKGROUND Hypothetically, delay between melanoma diagnosis and SLNB could affect outcomes, either adversely by allowing growth and dissemination of metastases, or beneficially by allowing development of an anti-melanoma immune response. Available data are conflicting about the effect of SLNB delay on patient survival. Our objective was to determine whether delay between initial diagnosis and SLNB affects outcomes in patients with cutaneous melanoma. STUDY DESIGN We performed query and analysis of a large prospectively maintained database of patients with primary cutaneous melanomas undergoing SLNB. An independent dataset from MSLT-1 (Multicenter Selective Lymphadenectomy Trial-1) was used for validation. Primary outcomes included disease-free survival and melanoma-specific survival. RESULTS Early and delayed SLNB were defined as less than 30 and 30 or more days from initial diagnosis, respectively. There were 2,483 patients that met inclusion criteria. Positive sentinel lymph nodes were identified in 17.4% (n = 432). Among all patients, 42% had SLNB 30 or more days after diagnosis and 37% of positive sentinel lymph nodes were at 30 or more days. No differences in sex, anatomic site, or histopathologic features were identified between the 2 groups. There was no difference in melanoma-specific survival or disease-free survival between those undergoing early or delayed SLNB. Examination of MSLT-1 trial data similarly demonstrated no difference in survival outcomes. CONCLUSIONS This, the largest study on this subject to date, found no adverse impact on long-term clinical outcomes of patients due to delay of SLNB beyond 30 days. The MSLT-1 data confirm this result. Patients can be reassured that if the operation is performed 30 or more days after diagnosis, it will not cause harm.

Timing of sentinel node biopsy independently predicts disease-free and overall survival in clinical stage I-II melanoma patients: A multicentre study of the Italian Melanoma Intergroup (IMI)

“…The results of the present study should be considered in the context of the current literature. To date, the impact of a longer time interval until SNB on DFS and OS has been reported in 11 studies [ [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] ], which included patients with negative and/or positive SN ( Table 4 ). The results so far reported are conflicting because of heterogeneity in patients' characteristics, number of patients included according to the SN status, the time interval to SNB which varies from 7 to 59 days and finally, the median follow-up.…”

“… Author Number of patients Cut-off for early/delayed time interval to SNB (days) Median follow-up Multivariable analysis on DFS (Cox proportional hazard model) Multivariable analysis on OS (Cox proportional hazard model) Fortes [ 9 ] SN−: 607 SN+:141 30 Not specified Not reported SN−: HR [Early versus delayed] 1.77, 95%CI 0.97–3.26 SN+: HR [Early versus delayed] 0.29, 95%CI 0.11–0.77 [MSS] Carpenter [ 10 ] SN−: 412 SN+: 61 28 (A) and 56 (B) 2.8 years A) HR [Early versus delayed] 1.01, 95%CI 0.64–1.58 B) HR [Early versus delayed] 0.80, 95%CI 0.37–1.73 A) HR [Early versus delayed] 1.05, 95%CI 0.61–1.82 B) HR [Early versus delayed] 0.89, 95%CI 0.34–2.34 Crawford [ 11 ] 723 (SN− and SN+) Analysed as continuous variable 3.34 years Not reported HR [1 day increase] 0.89, 95%CI 0.74–1.07 [OS calculated from the primary melanoma excision] Oude Ophuis [ 12 ] SN−: 2841 SN+: 705 43 50 months Not reported HR [1 day increase] 1.0, 95%CI 0.99–1.01 Tejera-Vaquerizo [ 13 ] SN−: 1498 SN+: 464 40 46 months Not significant for SN− and SN+ (data not shown) [DFS calculated from the excision of the primary melanoma plus 120 days] SN−: HR [Early versus delayed] 2.6, 95%CI 1.5–4.6 SN+: Not significant (data not shown) [OS calculated from the excision of the primary melanoma plus 120 days. MSS] Nelson [ 14 ] SN−: 2051 SN+: 432 30 95.7 months HR [Early versus delayed] 0.98, 95%CI 0.81–1.18) HR [Early versus delayed] 1.05, 95%CI 0.83–1.34 [MSS ] Tejera-Vaquerizo [ 15 ] SN−: 274 SN+: 66 SN not found: 10 40 103 months HR [Early versus delayed] 1.68, 95%CI 1.07–2.65 [DFS calculated from primary excision. Propensity score matching] HR [Early versus delayed] 1.77, 95%CI 1.11–2.83 ...…”

“…With regards to SN-negative cohorts, the results are still conflicting. In seven studies, the interval between primary melanoma excision and SNB was not associated with DFS and/or OS [ [9] , [10] , [11] , [12] , 14 , 17 , 19 ]. More recently, Tejera-Vaquerizo et al.…”

Management of Melanoma during Pregnancy: A Case Series of 11 Women Treated at NYU Langone Health

“…The authors felt it was safe to delay the SLNB of lower risk patients based on studies in non-pregnant patients that did not show a difference in overall survival when SLNB was delayed [14]. However, studies only examined delays of 30–40 days, which is shorter than the delay that might occur during pregnancy [16]. Patients at lower risk for nodal involvement should have individualized discussions with their oncologists about the timing of SLNB.…”

ECCO essential requirements for quality cancer care for melanoma: Defining how to organise care

“…Patients with suspected melanoma must have a diagnostic excision within 1 week and be referred to be staged within 3 weeks. However, for early stage patients who have had a radical diagnostic excision, the time taken for a sentinel node procedure is not relevant to prognosis (Nelson et al, 2017;Oude Ophuis et al, 2016). …”