A nomogram to identify high-risk melanoma patients with a negative sentinel lymph node biopsy

• Published in: Journal of the American Academy of Dermatology 2019-03, Vol.80 (3), p.722-726
• Main Authors: Bertolli, Eduardo, de Macedo, Mariana Petaccia, Calsavara, Vinícius Fernando, Pinto, Clovis Antonio Lopes, Duprat Neto, João Pedreira
• Format: Article
• Language: English
• Subjects: melanoma; nomograms; recurrence; sentinel lymph node biopsy
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2018.10.060

Melanoma patients with negative nodes after sentinel lymph node biopsy are a heterogeneous group. Current guidelines fail to adequately stratify surveillance and treatment for this group. Also, there is scarce data on adjuvant treatments for these patients. To create a nomogram including clinical and pathologic characteristics capable of evaluating the risk for recurrence of primary melanoma patients with negative sentinel lymph node biopsies (SLNBs). We used a retrospective cohort of patients who underwent SLNB during 2000-2015 at a single institution. Our cohort comprised 1213 patients. Among these patients, 967 (79.7%) had a negative SLNB, and mean follow-up was 59.67 months. There were 133 recurrences (13.8%); 45 (33.8%) presented with nodal recurrence, and 35 (26.3%) recurred where a SLNB was performed. Breslow thickness, ulceration, and microsatellitosis were found to be predictive of risk for recurrence at 1, 2, 5, and 10 years. Single center analysis. We created a predictive nomogram for melanoma patients with negative SLNBs. This nomogram is easy to use and identifies high-risk patients who should have more strict surveillance and be considered for adjuvant treatment.