Does Delayed Lymph Node Biopsy Affect Survival Rates in Melanoma?

06/29/17

Recent research compared survival outcomes of patients newly diagnosed with melanoma who received a sentinel lymph node biopsy within 30 days and those who received biopsy after 30 days, published in the Journal of the American College of Surgeons (published online June 28, 2017; doi:10.1016/j.jamcollsurg.2017.05.013).

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Current guidelines for management of melanoma include surgical removal of the layers of skin cancer and a lymph node biopsy. Patients with a positive sentinel node biopsy are likely to undergo complete lymph node dissection to lower the risk of recurrence. Delaying biopsy after initial diagnosis could have a negative or positive; cancerous cells could grow and spread to lymph nodes, or the body’s immune system may develop an anti-melanoma response.

Mark Faries, MD, FACS, co-director, melanoma program, The Angeles Clinic and Research Institute (Los Angeles, CA), and colleagues conducted the largest study to date to analyze the effect of delayed sentinel lymph node biopsy on survival of patients with melanoma. A total of 2483 patients were included who underwent wide local excision and sentinel lymph node biopsy for melanoma skin cancer from 1995 to 2015. Researchers assessed whether later lymph node biopsies (more than 30 days from diagnosis) were associated with different outcomes compared with earlier lymph node biopsies (less than 30 days from diagnosis).

Average follow-up time was eight years. Primary outcomes included disease-free survival and melanoma-specific survival.

Positive sentinel lymph nodes were identified in 17% of patients (n = 432). Fifty-eight percent of patients underwent early sentinel lymph node biopsy.

Researchers observed no significant difference in melanoma-specific survival or disease-free survival in patients in either cohort.

An independent dataset from a multicenter prospective randomized trial was analyzed to validate this finding. Similar survival outcomes were reported.

"When we talk to patients diagnosed with melanoma, the main rationale is to get the surgical procedure over and done with and get the information and resources they need so that they can move on," Dr Faries said in a press release (June 28, 2017). "But people can be reassured that if they are in a situation where, for one reason or another, they need to wait to have an operation, that's okay too."—Zachary Bessette