Multi-institutional melanoma lymphatic mapping experience: The prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients

Purpose: To compare the effect of pathologic sentinel lymph node (SLN) stat us with that of other known prognostic factors on recurrence and survival i n patients with stage I or II cutaneous melanoma. Patients and Methods: We reviewed the records of 612 patients with primary cutaneous melanoma who underwent lymphatic mapping and SLN biopsy between J anuary 1991 and May 1995 to determine the effects of tumor thickness, ulcer ation, Clark level, location, sex, and SLN pathologic status on disease-fre e and disease-specific survival. Results: In the 580 patients in whom lymphatic mapping and SLN biopsy were successful, the SLN was positive by conventional histology in 85 patients ( 15%) but negative in 495 patients (85%), SLN status was the mast significan t prognostic factor with respect to disease-free and disease-specific survi val by univariate and multiple covariate analyses. Although tumor thickness and ulceration influenced survival in SLN-negative patients, they provided no additional prognostic information in SLN-positive patients. Conclusion: Lymphatic mapping and SLN biopsy is highly accurate in staging nodal basins at risk for regional metastases in primary melanoma patients a nd identifies those who may benefit from earlier lymphadenectomy. Furthermo re, pathologic status of the SLN in these patients with clinically negative nodes is the most important prognostic factor for recurrence. The informat ion from SLN biopsy is particularly helpful in establishing stratification criteria for future adjuvant trials. (C) 1999 by American Society of Clinic al Oncology.