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Melanoma

E305: The Utility of Sentinel Lymph Node Biopsy in Elderly Patients with Melanoma

    ePoster Abstract Author(s)

  • Hanna Kakish, MD

    Research fellow
    University Hospitals Cleveland Medical Center
    Cleveland, Ohio, United States

    • Submitter(s)

  • Hanna Kakish, MD

    Research fellow
    University Hospitals Cleveland Medical Center
    Cleveland, Ohio, United States

    • Author(s)

  • Hanna Kakish, MD

    Research fellow
    University Hospitals Cleveland Medical Center
    Cleveland, Ohio, United States

  • Richard S. Hoehn, MD

    Surgeon
    University Hospitals Cleveland Medical Center
    Cleveland, Ohio, United States

  • LR

    Luke D. Rothermel, MD MPH

    Surgeon
    University Hospitals Cleveland Medical Center, United States

Introduction: Sentinel lymph node biopsy (SLNB) provides prognostic information and informs treatment decisions for qualified melanoma patients. However, SLNB is performed less often for older patients. We investigated the association of SLNB on overall and cancer-specific survival in the elderly.

Methods: We retrospectively reviewed that the National Cancer Database (NCDB: 2012-2020) and the Surveillance, Epidemiology, and End Results database (SEER: 2010-2019) for cT2-4N0M0 melanoma patients ≥70 years. We assessed the independent association of patient, tumor, and hospital factors with SLNB performance and nodal positivity using the NCDB. Next, we evaluated the independent impact of SLNB on overall survival (OS) at increasing age cut-offs. However, given the higher prevalence of non-cancer causes of death in the geriatric population, we similarly evaluated the independent impact of SLNB with melanoma specific survival (MSS) using SEER.

Results: We identified 42,144 and 11,679 patients in the NCDB and SEER datasets, respectively. SLNB occurred in 59.0%-65.7% of patients, of whom 13.6%-15.3% had a positive SLNB. Increasing age was significantly associated with decreased SLNB performance and worse MSS (80-89 years: HR= 1.28; and ≥90 years: HR= 1.65, p< 0.05) among all patients. SLNB was more common for mitotic tumors and at high-volume hospitals. On adjusted analysis, undergoing SLNB was independently associated with improved MSS (overall HR= 0.76, 95% CI= 0.68-0.84) for patients up to 86 years old (Figure 1). When SLNB was performed, positive SLNB was independently associated with inferior MSS (HR= 3.11, p< 0.05) and OS (HR= 1.62, p< 0.05). The former association was significant across all age groups except for OS in patients ≥90 years, which showed no significant difference.

Conclusions:

SLNB adds prognostic benefit even for elderly patients with melanoma ≥70 years old. The association of SLNB with improved MSS maintained significance up to the age of 86 years old, with lower patient numbers creating wider confidence intervals for older age groups. Nonetheless, increasing age predicted less SLNB utilization, which if not justified by frailty and other surgery contraindications, exposes a disparity in the care of elderly patients with melanoma.

Learning Objectives:

  • Upon completion, participant will be able to identify disparities in sentinel lymph node biopsy performance and rates of nodal positivity in patients ≥70 years of age
  • Upon completion, participant will be able to understand the association of sentinel lymph node biopsy with overall survival and melanoma-specific survival in qualifying melanoma patients ≥70 years of age
  • Upon completion, participant will be able to identify an age cutoff for the association of sentinel lymph node biopsy and improved melanoma-specific survival