ArticleWorld journal of surgical oncology2026
Sentinel lymph node status and oncological outcomes of high-risk and low-risk cutaneous primary melanoma.
Article in World journal of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionThe role of sentinel lymph node biopsy (SLNB) in clinically node-negative melanoma has been questioned in the era of effective adjuvant immunotherapy. We evaluated the staging and prognostic value of SLNB in a single-centre cohort, with emphasis on patients with “high-risk” primary tumours.
methodsWe retrospectively analysed 300 consecutive patients with cutaneous melanoma who underwent wide local excision with SLNB at a tertiary melanoma centre (April 2018–April 2023). Patients were stratified by AJCC 8th edition T stage into low-risk (T1–T3a) and high-risk (T3b–T4b) groups. Outcomes included SLN positivity, recurrence, and disease-free survival (DFS). DFS was assessed using Kaplan–Meier methods with log-rank testing; restricted mean survival time (RMST) was calculated to 3 years. In high-risk patients with available data, the Melanoma Institute of Australia sentinel node risk tool was evaluated for discrimination and calibration.
resultsMedian age was 60.7 years and 51.3% were male. Overall SLN positivity was 22.0% (66/300) and was higher in high-risk than low-risk melanoma (31.5% [28/89] vs. 18.0% [38/211], P = 0.009). Recurrence occurred in 16.0% (48/300), more frequently in high-risk patients (31.5% vs. 9.5%). Estimated DFS at 1 and 3 years was 96.6% and 81.8% for low-risk melanoma versus 87.9% and 68.6% for high-risk melanoma (log-rank P < 0.001); RMST to 3 years favoured the low-risk group by 115.9 days (95% CI 20.8–213.3). SLNB resulted in substantial stage migration in high-risk clinically node-negative patients, identifying pathological stage IIIC disease in 31.5% (28/89) who would otherwise be classified as stage IIB/IIC.
conclusionSLNB continues to provide clinically important staging and prognostic information, particularly in high-risk clinically node-negative melanoma where occult nodal disease is common. Omitting SLNB risks systematic understaging and loss of prognostic resolution.
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