The effect of delay time between primary melanoma biopsy and sentinel lymph node dissection on sentinel node status, recurrence, and survival

Abstract

For primary melanoma, there is a delay between the initial skin biopsy and sentinel lymph node dissection, which may cause anxiety for the patient. The consequences of this delay on disease progression are unknown. The goal of this study was to determine whether delay time for sentinel node dissection from the initial cutaneous melanoma biopsy affects patient outcomes. A retrospective analysis of 492 patients with melanoma who underwent a sentinel node dissection between 1993 and 1999 was carried out. The endpoints assessed were sentinel node tumor status, recurrence, and mortality. Time to sentinel node dissection was compared between patients with positive and negative sentinel nodes. Long-term survival and recurrence were evaluated in relation to the time between the cutaneous biopsy and the sentinel node dissection (delay time), comparing less than 40 days with at least 40 days. In total, 15.9% of patients had positive sentinel nodes. The median follow-up was 11.7 years. Positive sentinel node patients had a median delay of 35 days between the primary melanoma biopsy and the sentinel node dissection compared with 41 days for negative sentinel node patients (P=0.5). Kaplan-Meier survival curves showed that a delay time of less than 40 days versus at least 40 days was not related to recurrence of melanoma (log-rank P=0.13) or overall survival (log-rank P=0.14). On multivariate analysis of age, thickness, ulceration, and sentinel node status, there was no difference in disease-free survival (P=0.58) or overall survival (P=0.53) between the less than 40 days and the at least 40 days groups. A modest delay in sentinel node dissection from the initial melanoma biopsy does not adversely affect sentinel node status, recurrence, nor survival.

The interval between primary melanoma excision and sentinel node biopsy is not associated with survival in sentinel node positive patients – An EORTC Melanoma Group study

“…To date, only two studies have reported on this topic. Parrett et al found no adverse effects on survival for a time interval of <40 days vs. > 40 days, while Tejera-Vaquerizo et al reported a detrimental effect of a time interval of <40 days at the expense of SN negative patients [11,12]. These contradicting findings are not sufficient to answer the question which effects, if any, time interval may have on survival.…”

“…SN tumor burden according to the Rotterdam criteria [13,20] is significantly more often high in those patients undergoing SNB after a time interval of 47 days patients from a single institution [12]. With a median time interval of 40 days, no differences in DFS, OS and MSS were found, nor any significant difference in SN positivity rates.…”

Determination of the impact of melanoma surgical timing on survival using the National Cancer Database

“…19 Lastly, Parret et al found no difference in OS after analyzing TTI on the basis of groups of patients who waited less than or more than 40 days. 20 …”

Effect of time to sentinel-node biopsy on the prognosis of cutaneous melanoma

“…To our knowledge, only two studies to date, published by Parrett et al,[3] and at the same time, in this volume, the study of Oude Ophuis et al[16], have studied the impact of the timing of sentinel-node biopsy on survival in melanoma patients. In Parrett’s study, surprisingly, they observed an increased frequency of recurrence and melanoma-specific mortality in patients with a delay time of less than 40 days.…”

“…They found no significant differences in survival but the arm of patients treated by immediate lymphadenectomy (n=54) showed a slight tendency to metastasize before with a worse prognosis (n=55). More recently, Parrett et al evaluate the effect of time to sentinel-node biopsy on sentinel-node involvement, recurrence, and mortality, and found no significant differences in survival on comparing a delay time of less than 40 days with one of 40 days or more[3]. They did, however, detect a trend towards higher melanoma-specific mortality in patients who underwent early sentinel-node biopsy (less than 40 days) and attributed this to a higher frequency of ulceration and thicker tumors in this group.…”