In the Journals

SLNB did not improve survival in head and neck melanoma

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December 4, 2014

Patients with head and neck melanoma who underwent sentinel lymph node biopsy derived no disease-specific survival benefit compared with patients who did not undergo the procedure, according to study results.

Prior research established sentinel lymph node biopsy (SLNB) offers prognostic information for patients with melanoma, but previous studies have not demonstrated a survival benefit.

For this reason, Steven M. Sperry, MD, clinical assistant professor in the department of otolaryngology-head and neck surgery at University of Iowa Health Care, and colleagues assessed the association between SLNB and survival in patients who developed melanoma on head and neck subsites.

Researchers used the SEER database to 7,266 eligible patients (age range, 18 to 84 years) treated between 2004 and 2011. Of these patients, 54% underwent SLNB and 46% did not.

Sperry and colleagues grouped patients into one of three tumor thickness categories: thin melanomas (>0.75 mm to 1 mm in Breslow thickness), intermediate (>1 mm to 4 mm) and thick (more than 4 mm). Researchers also matched patients in five age categories.

The final analysis included 552 matched pairs with thin melanomas, 1,404 matched pairs with intermediate-thickness melanomas, and 354 matched pairs with thick melanomas.

In the intermediate-thickness cohort, 5-year disease-specific survival (DSS) was 89% among those who underwent SLNB and 88% for those who underwent nodal observation (P=.3). The HR for melanoma-specific mortality was 0.87 (95% CI, 0.66-1.14) for those who underwent SLNB.

Researchers observed no significant difference in DSS among patients with thin or thick melanomas. The HRs for DSS for SLNB compared with nodal observation were 1.53 (95% CI, 0.75-3.13) among patients with thin melanomas and 0.8 (95% CI, 0.56-1.15) among patients with thick melanomas.

“This study has not identified a statistically significant association between treatment including SLNB and improved DSS for head and neck melanoma,” Sperry and colleagues wrote. “Furthermore, we suggest that the size of the association is unlikely to be clinically relevant for patients. It is unlikely that another randomized controlled trial with adequate power will ever be designed to answer this question. Therefore, observational data analyses … may remain the best level of evidence regarding this important clinical question … Our results do not provide evidence to warrant further study to assess the therapeutic survival benefit of SLNB for head and neck melanoma.”

Disclosure: The researchers report no relevant financial disclosures. 

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