Time interval between diagnostic excision-biopsy of a primary melanoma and sentinel node biopsy: effects on the sentinel node positivity rate and survival outcomes

Mary-Ann El Sharouni; Richard A Scolyer; Carla H van Gils; Sydney Ch'ng; Omgo E Nieweg; Thomas E Pennington; Robyn P M Saw; Kerwin Shannon; Andrew Spillane; Jonathan Stretch; Arjen J Witkamp; Vigfús Sigurdsson; John F Thompson; Paul J van Diest; Serigne N Lo

doi:10.1016/j.ejca.2021.12.035

Time interval between diagnostic excision-biopsy of a primary melanoma and sentinel node biopsy: effects on the sentinel node positivity rate and survival outcomes

Eur J Cancer. 2022 May:167:123-132. doi: 10.1016/j.ejca.2021.12.035. Epub 2022 Mar 5.

Authors

Affiliations

¹ Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
² Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia.
³ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands.
⁴ Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
⁵ Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
⁶ Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Breast and Melanoma Surgery, Royal North Shore Hospital, Sydney, NSW, Australia.
⁷ Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
⁸ Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
⁹ Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. Electronic address: john.thompson@melanoma.org.au.
¹⁰ Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
¹¹ Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.

PMID: 35256245
DOI: 10.1016/j.ejca.2021.12.035

Abstract

Introduction: The optimal time interval between diagnostic excision of a primary cutaneous melanoma and sentinel node (SN) biopsy is unknown. The current study sought to determine whether this interval influenced the SN-positivity rate, recurrence or survival.

Methods: Data collected from 2004 to 2014 for a Dutch population-based cohort of patients with melanoma who underwent SN biopsy (SNB) within 100 days of initial diagnosis (n = 7660) and for a similarly specified cohort from a large Australian melanoma treatment centre (n = 3478) were analysed. Time to SNB was analysed continuously (in weeks) and categorically (per month). The effects of SNB timing on SN-positivity were assessed using multivariable logistic regression, and its effects on recurrence-free survival (RFS) and overall survival (OS) were assessed using Cox proportional hazard regression analyses. Advanced modelling using a multivariable Cox model with penalised splines for modelling the continuous effects of time to SNB on RFS and OS was also performed.

Results: In neither the Dutch nor the Australian cohort was there a significant association between time to SNB and SN-positivity in either cohort, nor was there an impact of time to SNB on RFS or OS in either cohort. The spline-based HR curves for RFS and OS confirmed these findings.

Conclusions: The time interval between diagnostic excision of a primary melanoma and SNB did not influence the SN-positivity rate or survival outcomes. This provides reassurance that neither early nor delayed definitive wide excision and SNB will adversely affect prognosis.

Keywords: Excision; Melanoma; Sentinel node; Survival; Time.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Australia
Humans
Melanoma* / pathology
Prognosis
Sentinel Lymph Node Biopsy
Skin Neoplasms* / pathology
Syndrome