Core Concepts
Redesigning SLNB guidelines in melanoma based on additional variables can enhance patient care and outcomes.
Abstract
Standalone Note here
The content delves into the importance of Sentinel Lymph Node Biopsy (SLNB) in melanoma staging and prognostication. It highlights the current guidelines set by the American Joint Committee on Cancer (AJCC) and discusses the impact of various factors on SLNB positivity rates. The study aims to propose a redesign of SLNB guidelines to improve patient-specific recommendations, reduce unnecessary invasive procedures, and enhance prognostication accuracy.
Abstract and Introduction
- SLNB is crucial for melanoma staging.
- Negative SLNBs can lead to unnecessary procedures.
- Parameters for SLNB candidates need improvement.
Methods
- Systematic review of current AJCC guidelines.
- Impact of age, mitotic rate, and other factors on SLNB positivity rates.
Results
- Variables significantly affect SLNB positivity rates.
- Evidence supports redesigning SLNB guidelines.
Conclusions
- Integrating new variables with AJCC guidelines can enhance patient care.
- Aim to reduce invasive procedures and improve prognostication.
Introduction
- Melanoma is a common cancer in the US.
- SLNB procedure, risks, and importance in staging.
- Positive SLNB impacts management significantly.
Current Guidelines
- Recommendations for SLNB based on tumor thickness.
- Complication rates and SLNB positivity rates.
- Opportunities to improve patient care.
Factors Affecting SLNB Positivity
- Mitotic rate as a predictor of SLNB positivity.
- Modifiers like age, ulceration, and lymphovascular invasion.
- Need for expanded criteria for SLNB candidacy.
Subtypes and Anatomical Location
- Nodular and acral lentiginous melanoma linked to SLNB positivity.
- Anatomical locations influence SLNB positivity rates.
- Importance of evaluating subtype and location for SLNB candidacy.
Immunocompromised Status
- Limited literature on its impact on SLNB positivity.
- Speculation on increased SLNB positivity rates.
- Need for further exploration in this area.
Stats
Currently, the overall incidence of positive sentinel lymph nodes in patients undergoing SLNB ranges from 15% to 20%.
The overall complication rate of SLNB in melanoma patients was found to be 11.3%.
Chang et al reported a 12% SLNB positivity rate for melanomas 1.01 to 1.99 mm in depth.
Paek et al reported positivity rates of 19%, 32%, and 45% for melanomas 1.01 to 2.0 mm, 2.01 to 3.99 mm, and ≥4.0 mm in depth, respectively.
Mraz-Gernard et al reported positivity rates of 17%, 16%, 50%, 41%, and 17% for melanomas 1.0 to 1.9 mm, 2.0 to 2.9 mm, 3.0 to 3.9 mm, 4.0 to 4.9 mm, and 5.0 to 17.0 mm in depth, respectively.
Quotes
"Recognizing this as an opportunity to improve quality patient care, the authors investigated how to best yield high SLNB positivity rates and decrease the number of unnecessary SLNBs."
"Doing so will likely lead to higher SLNB positivity rates and reduce the number of unnecessary SLNBs performed."
"Nodular and acral lentiginous subtypes of melanomas may be prone to developing more aggressive features, important factors to evaluate when deciding candidacy for a SLNB."