Hospital-Based study of compliance with nCCN guidelines and predictive factors of sentinel lymph node biopsy in the setting of thin melanoma using the national cancer database

Sarah A. Hayek, Amanda Munoz, James T. Dove, Marie Hunsinger, Tania Arora, Jeffrey Wild, Mohsen Shabahang, Joseph Blansfield

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Thin melanoma is the most common form of melanoma in the United States. The National Comprehensive Cancer Network (NCCN) has guidelines for sentinel lymph node biopsy (SLNB) which recommend “discuss and consider” SLNB for invasion >0.75 mm and “discuss and offer” SLNB for invasion >0.75 mm with suspicious features. This study looked at compliance with NCCN guidelines and factors that are predictive of a positive SLNB. This is a retrospective study of patients diagnosed with thin melanoma 2012–2013 using the National Cancer Database. A total of 26,456 patients met study qualifications. Univariate analysis showed that 76 per cent of patients meeting criteria underwent SLNB. Patients recommended to “discuss and consider” received SLNB 53 per cent of the time and those not recommended for SLNB received SLNB 20 per cent of the time. On multivariate analysis, depth was not predictive for positive SLNB whereas mitoses and ulceration were. Other factors predictive of positive SLNB were nodular cell type, lymphovascular invasion, and Clark’s level greater than or equal to IV. Patients with thin melanoma that meet NCCN guidelines for SLNB undergo this procedure in good compliance but those who do not meet criteria continue to receive SLNB. Positive predictive factors for positive SLNB include mitoses, ulceration, Clark’s level, and primary site.

Original languageEnglish (US)
Pages (from-to)672-679
Number of pages8
JournalAmerican Surgeon
Volume84
Issue number5
StatePublished - May 2018
Externally publishedYes

ASJC Scopus subject areas

  • Surgery

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