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. 2023 May 8:13:1143354.
doi: 10.3389/fonc.2023.1143354. eCollection 2023.

The role of imaging and sentinel lymph node biopsy in patients with T3b-T4b melanoma with clinically negative disease

Marianna V Papageorge  1 , Renee M Maina  2 , Amber Loren O King  3 , Victor Lee  3 , Raymond Baumann  4 , Darko Pucar  5 , Stephan Ariyan  1 , Sajid A Khan  1 , Sarah A Weiss  6 , James Clune  1 , Kelly Olino  1
Affiliations

The role of imaging and sentinel lymph node biopsy in patients with T3b-T4b melanoma with clinically negative disease

Marianna V Papageorge et al. Front Oncol. .

Abstract

Background: Previous studies demonstrate minimal utility of pre-operative imaging for low-risk melanoma; however, imaging may be more critical for patients with high-risk disease. Our study evaluates the impact of peri-operative cross-sectional imaging in patients with T3b-T4b melanoma.

Methods: Patients with T3b-T4b melanoma who underwent wide local excision were identified from a single institution (1/1/2005 - 12/31/2020). Cross-sectional imaging was defined as body CT, PET and/or MRI in the perioperative period, with the following findings: in-transit or nodal disease, metastatic disease, incidental cancer, or other. Propensity scores were created for the odds of undergoing pre-operative imaging. Recurrence free survival was analyzed using the Kaplan-Meier method and log-rank test.

Results: A total of 209 patients were identified with a median age of 65 (IQR 54-76), of which the majority were male (65.1%), with nodular melanoma (39.7%) and T4b disease (47.9%). Overall, 55.0% underwent pre-operative imaging. There were no differences in imaging findings between the pre- and post-operative cohorts. After propensity-score matching, there was no difference in recurrence free survival. Sentinel node biopsy was performed in 77.5% patients, with 47.5% resulting in a positive result.

Conclusion: Pre-operative cross-sectional imaging does not impact the management of patients with high-risk melanoma. Careful consideration of imaging use is critical in the management of these patients and highlights the importance of sentinel node biopsy for stratification and decision making.

Keywords: cross-sectional imaging; high-risk melanoma; recurrence free survival; sentinel lymph node (SLN) biopsy; surgical management.

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Conflict of interest statement

The reviewer KE declared a shared affiliation with the author SW to the handling editor at the time of review. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Patient selection criteria.
Figure 2
Figure 2
Imaging findings stratified by imaging cohort. This figure compares specific findings (defined as in-transit or nodal disease, metastatic disease, incidental cancer or other) between the pre-operative imaging cohort (blue) and the post-operative imaging cohort (orange). There were no statistically significant differences identified between the two groups.
Figure 3
Figure 3
Recurrence rates stratified by imaging cohort. This figure compares overall recurrence rates between the pre-operative imaging cohort and the post- operative imaging cohort. There was no statistically significant difference identified between the two groups.
Figure 4
Figure 4
Overall recurrence free survival after propensity-score matching. This figure compares overall recurrence free survival after propensity score matching between the pre- operative imaging cohort (blue) and the post-operative imaging cohort (red). There was no statistically significant difference in survival between the two groups.
See this image and copyright information in PMC

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