• Chloe Friedman, Madison Lyon, Robert J Torphy, Daniel Thieu, Patrick Hosokawa, Rene Gonzalez, Karl D Lewis, Theresa M Medina, Matthew J Rioth, William A Robinson, Nicole Kounalakis, Martin D McCarter, and Ana L Gleisner.
• Department of Surgery, University of Colorado, Aurora, Colorado.
• J Surg Oncol. 2019 Dec 1; 120 (7): 1276-1283.

ObjectiveTo 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.MethodsPatients 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.ResultsOf 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.ConclusionsThe risk predictions obtained from the nomogram allow for more accurate selection of patients who could benefit from SLNB.© 2019 Wiley Periodicals, Inc.

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