Research LetterSentinel lymph node biopsy for vulvar melanoma: trends in tumor stage-specific utilization
Section snippets
Objective
Vulvar melanoma is a rare malignancy associated with a poor prognosis that has been understudied. Previously, its surgical management included vulvectomy and complete bilateral inguinofemoral lymphadenectomy.1 In cutaneous melanomas, the standard of care for surgical nodal evaluation is performing sentinel lymph node (SLN) biopsy at excision of intermediate-thickness lesions.1,2 However, lymph node dissection in the inguinofemoral region can result in morbidity; thus, SLN biopsy use for vulvar
Study Design
This population-based retrospective cohort study used the National Cancer Institute’s Surveillance, Epidemiology, and End Result Program from 2004 to 2018. The study population was women with vulvar melanoma without distant metastasis who underwent vulvectomy and had data regarding the method of nodal evaluation. The exposure assignment was based on nodal evaluation: lymphadenectomy, SLN biopsy, or no surgical nodal evaluation. The main outcomes were (1) temporal trends of lymphadenectomy or
Results
A total of 729 women with T1 to T4 vulvar melanoma were included in the analysis. For T1 disease (n=215), the use of SLN biopsy significantly increased from 16.7% to 38.9% (P=.002) over time, whereas the use of lymphadenectomy decreased from 31.0% to 16.7% (P=.057) (Figure, A). For T2 (n=156) and T3 (n=120) diseases, the frequency of SLN biopsy was unchanged throughout the study (T2 disease: 22.6%–26.6%; P=.279; T3 disease: 27.3%–37.0%; P=.812) (Figure, B and C). For T4 disease (n=238), there
Conclusion
This large sample size, population-based study found an important trend in SLN biopsy use for vulvar melanoma according to local tumor characteristics. There was an increase in SLN biopsy use in both T1 and T4, but not T2 and T3, vulvar melanomas in the past decade. Although SLN biopsy is standard in T2 to T3 cutaneous melanoma,2 it was less utilized in T2 to T3 vulvar melanoma. Further research is needed to determine whether these increasing trends of SLN biopsy use have truly resulted in
References (6)
- et al.
Gynecologic Cancer InterGroup (GCIG) consensus review for vulvovaginal melanomas
Int J Gynecol Cancer
(2014) - et al.
Sentinel lymph node biopsy and management of regional lymph nodes in melanoma: American Society of Clinical Oncology and Society of Surgical Oncology clinical practice guideline update
J Clin Oncol
(2018) - et al.
Vulvar melanoma: is there a role for sentinel lymph node biopsy?
Cancer
(2002)
Cited by (3)
Role of immunotherapy for lymph node positive vulvar melanoma: utilization and outcomes
2023, International Journal of Gynecological CancerVulvar Malignant Melanoma: A Narrative Review
2022, Cancers
This study was supported by the Ensign Endowment for Gynecologic Cancer Research (K.M.). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
The following were outside of the current study: L.D.R. is a consultant of Quantgene, and K.M. received honorarium from Chugai, textbook editorial free from Springer; and investigator meeting attendance fee from VBL Therapeutics (K.M.). The other authors report no conflict of interest.
This study used publicly available, deidentified data and was deemed exempt by the University of Southern California Institutional Review Board (HS-16-00481).
The data that support the findings of this study are openly available in the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program at http://seer.cancer.gov/.
K.M. affirms that the manuscript is an honest, accurate, and transparent account of the study being reported, that no important aspects of the study have been omitted, and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. The SEER Program is the source of the deidentified data used, and the program has not verified and is not responsible for the statistical validity of the data analysis or the conclusions derived by the study team.