A nomogram to predict node positivity in patients with thin melanomas helps inform shared patient decision making.
J Surg Oncol
; 120(7): 1276-1283, 2019 Dec.
Article
in En
| MEDLINE
| ID: mdl-31602665
ABSTRACT
OBJECTIVE:
To develop a nomogram to estimate the probability of positive sentinel lymph node (+SLN) for patients with thin melanoma and to characterize its potential impact on sentinel lymph node biopsy (SLNB) rates.METHODS:
Patients diagnosed with thin (0.5-1.0 mm) melanoma were identified from the National Cancer Database 2012 to 2015. A multivariable logistic regression model was used to examine factors associated with +SLN, and a nomogram to predict +SLN was constructed. Nomogram performance was evaluated and diagnostic test statistics were calculated.RESULTS:
Of the 21 971 patients included 10 108 (46.0%) underwent SLNB, with a 4.0% +SLN rate. On multivariable analysis, age, Breslow thickness, lymphovascular invasion, ulceration, and Clark level were significantly associated with SLN status. The area under the receiver operating curve was 0.67 (95% confidence interval, 0.65-0.70). While 15 249 (69.4%) patients had either T1b tumors or T1a tumors with at least one adverse feature, only 2846 (13.0%) had a nomogram predicted probability of a +SLN ≥5%. Using this cut-off, the indication for a SLNB in these patients would be reduced by 81.3% as compared to the American Joint Committee on Cancer 8th edition staging criteria.CONCLUSIONS:
The risk predictions obtained from the nomogram allow for more accurate selection of patients who could benefit from SLNB.Key words
Full text:
1
Database:
MEDLINE
Main subject:
Skin Neoplasms
/
Risk Assessment
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Decision Making
/
Nomograms
/
Sentinel Lymph Node
/
Melanoma
Type of study:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged
/
Female
/
Humans
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Male
/
Middle aged
Language:
En
Journal:
J Surg Oncol
Year:
2019
Type:
Article