Sentinel lymph node biopsy neck3/1/2024 Perhaps corresponding to the adoption of SLNB, long-term survival in melanoma has improved over the last four decades. 1, 2 SLNB has since been widely employed for clinically lymph node negative (cN0) intermediate depth melanomas and has allowed earlier detection, improved locoregional staging, expeditious primary and adjuvant treatment implementation, and risk-stratification for investigative therapies. Modern sentinel lymph node biopsy (SLNB) was first described by Morton in 1992. Immunosuppression (HR 3.01, p<0.01) and SLN status (HR 2.84, p<0.01) were associated with recurrence free survival, and immunosuppression was the only factor significantly associated with regional recurrence (HR 6.59 p<0.01). SLN positivity (HR 3.13, p<0.01), angiolymphatic invasion (HR 3.19, p<0.01), and number of mitoses (p=0.0002) are significantly associated with MSS. OS was significantly associated with SLN positivity (hazard ratio (HR) 2.39, p<0.01), immunosuppression (HR 2.37 p<0.01), angiolymphatic invasion (HR 1.91 p<0.01), and ulceration (HR 1.86 p<0.01). 18 patients with local control and negative SLNB developed regional disease, indicating a false omission rate 6.4%, including 10 recurrences in previously unsampled basins. Among patients undergoing CLND following positive SLNB, 20 (27.4%) had at least one additional positive NSLN(s). Descriptive characteristics include mean age 53.5☑9 years, 26.8% female, median follow-up 4.9 years, and mean Breslow depth 2.52☑.87mm.
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