Population-Based Assessment of Surgical Treatment Trends for Patients With Melanoma in the Era of Sentinel Lymph Node Biopsy

Abstract

Stage migration is evident in the SEER registries in consort with increasing use of SLN biopsy. Although treatment trends are improving, SLN biopsy continues to be underused, particularly in the elderly and minority populations, in patients with truncal and head/neck melanomas, and also in some geographic regions of the United States.

The Biology and Clinical Relevance of Sentinel Lymph Nodes in Melanoma

“…Given this criteria, the positive SLN rate has been documented to be between 14-21% in most studies (Kapteijn et al, 1997;Leong et al, 2005;Morton et al, 1992Morton et al, , 2006Thompson et al, 2005). Despite these guidelines, population based studies have shown that only 50% of patients with stage IB and II who met the criteria for selective SLND actually undergo selective SLND (Bilimoria et al, 2009;Cormier et al, 2005). The factors for this are likely multi-factorial including insurance, geographic area, socioeconomic factors, and age.…”

Survival Differences Between Patients With Scalp or Neck Melanoma and Those With Melanoma of Other Sites in the Surveillance, Epidemiology, and End Results (SEER) Program

“…Histologic subtype and lymph node status variables were not included in our primary model because 41% of cases had histologic subtype recorded as "not otherwise specified," and 37% of cases had unknown lymph node status. In addition, the literature 12,13 suggests that patients with head/neck melanomas are less likely to undergo sentinel lymph node biopsy procedures than those with melanomas at other sites, which may result in a misclassification of lymph node status.…”

Melanoma Outcomes for Medicare Patients

“…Despite strong evidence that wide excision (a margin of Ն1 cm) for invasive melanoma should be the standard of care, [35][36][37] 25% of patients were treated with only simple excisional, shave, or punch biopsy. A more recent study by Cormier et al 38 also evaluated adherence to recommended surgical treatment for invasive melanoma, including sentinel lymph node biopsy. They found that from 1998 to 2001, about one third of patients in the SEER database received care that was nonadherent to current practice guidelines.…”