Prognostic usefulness of sentinel lymph node biopsy for patients who have clinically node negative, localized, primary invasive cutaneous melanoma: a Bayesian analysis using informative published reports.

OBJECTIVE

To assess the prognostic value of sentinel lymph node biopsy status for patients with localized, clinically node negative, primary invasive cutaneous melanoma.

DESIGN

Predictive value of positive or negative sentinel lymph node biopsy (SLNB) results for melanoma-related death, using raw numbers from informative publications.

SETTING AND PARTICIPANTS

Reports comprising 50 patients with cutaneous melanoma who had undergone SLNB, based on PubMed search (January 1, 1993, through June 3, 2010).

MAIN OUTCOME MEASURE

Melanoma-related death.

RESULTS

For the 2 informative reports of patients with tumors of intermediate thickness (1-4 mm), risk of melanoma-related death ranged from 26.2% to 31.6% for node-positive cases and from 9.7% to 15.6% for node-negative cases. Based on 4 informative reports of patients with thin tumors (≤ 1 mm), risk of melanoma-related death ranged from 0% to 0.6% for both node-positive and node-negative cases. For the single informative report of patients with thick tumors (≥ 4 mm), risk of melanoma-related death was 32.5% for node-positive cases and 30.1% for node-negative cases. For 19 informative case series with any tumor thickness, risk of melanoma-related death ranged from 0% to 47.8% for node-positive cases and from 0% to 13.3% for node-negative cases.

CONCLUSION

Prognostic information provided by SLNB status may be variably useful for patients who have tumors of intermediate thickness (1-4 mm) and not very useful for patients who have thin (≤ 1 mm) or thick (≥ 4 mm) tumors.