Differences in sentinel lymph node biopsy utilization in eligible melanoma patients treated with Mohs micrographic surgery or wide local excision: A population-based logistic regression model and survival analysis

• Published in: Journal of the American Academy of Dermatology 2023-04, Vol.88 (4), p.848-855
• Main Author: Knackstedt, Thomas J.
• Format: Article
• Language: English
• Subjects: Humans; Logistic Models; Lymph Node Excision; Male; melanoma; Melanoma - pathology; Mohs micrographic surgery; Mohs Surgery - methods; Retrospective Studies; Sentinel Lymph Node - pathology; sentinel lymph node biopsy; Sentinel Lymph Node Biopsy - methods; Skin Neoplasms - pathology; Survival Analysis; wide local excision
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2022.11.004

Primary melanoma management relies on tumor extirpation and staging sentinel lymph node biopsy (SLNB) in eligible patients. This study compares SLNB utilization in patients undergoing wide local excision (WLE) or Mohs micrographic surgery (MMS). American Joint Committee on Cancer seventh edition ≥ patients with T1b melanoma undergoing WLE or MMS in the Surveillance, Epidemiology, and End Results program were included. Propensity score matching was performed to compare patients who underwent MMS or WLE. Kaplan–Meier analysis and Fine–Gray cumulative incidence functions were used for overall and melanoma-specific survival. Eight hundred twenty-five MMS cases and 38,760 WLE cases were identified. SLNB was performed in 32.61% of MMS patients and 61.77% of WLE patients with positive rates of 12.5% and 14.82%, respectively. Multiple logistic regression of factors associated with SLNB utilization revealed that WLE, male gender, younger age, extremity location, and nodular and rare melanoma subtypes were significantly associated with increased odds of receiving SLNB whereas head and neck location and lentigo maligna melanoma subtype were significantly less likely to receive SLNB. Potential selection bias from a retrospective data set. Patients receiving WLE for ≥ T1b melanoma are more likely to receive a SLNB than patients undergoing MMS.