Biopsy-Based Management Improves Melanoma Outcomes
(HealthDay News) — Sentinel-node biopsy-based management of primary cutaneous melanomas is associated with improved long-term outcomes, according to a study published in the February 13 issue of the New England Journal of Medicine.
Donald L. Morton, MD, from the Saint John's Health Center in Santa Monica, Calif., and colleagues assessed outcomes for 2,001 patients with primary cutaneous melanomas. The patients were randomized to undergo wide excision and nodal observation, with lymphadenectomy for nodal relapse (observation group), or wide excision and sentinel-node biopsy, with immediate lymphadenectomy for biopsy-detected nodal metastases (biopsy group).
The researchers found that in the overall study population there was no significant treatment-related difference in the 10-year melanoma-specific survival rate. Among patients with intermediate-thickness melanomas (1.20–3.50 mm) and thick melanomas (>3.50 mm), the mean 10-year disease-free survival rates were significantly improved in the biopsy group versus the observation group (hazard ratios for recurrence or metastasis, 0.76 and 0.70, respectively). The 10-year melanoma-specific survival rate was significantly lower for those with versus without metastasis for intermediate thickness melanomas (hazard ratio for death from melanoma, 3.09) and thick melanomas (hazard ratio, 1.75). For patients with intermediate-thickness melanomas and nodal metastases, biopsy-based management correlated with improved 10-year distant disease-free survival (hazard ratio for distant metastasis, 0.62) and 10-year melanoma-specific survival (hazard ratio for death from melanoma, 0.56).
"These long-term results clearly validate the use of sentinel-node biopsy in patients with intermediate-thickness or thick primary melanomas," the authors write.
Several authors disclosed financial ties to the pharmaceutical and biotechnology industries; one author holds a patent on the molecular classification of melanoma which has been licensed to Myriad Genetics.