Annals of Surgical Oncology

, Volume 21, Issue 11, pp 3395–3400 | Cite as

Factors Influencing the Use of Sentinel Lymph Node Biopsy in the Netherlands

  • Anna M. Huismans
  • Maarten G. Niebling
  • Kevin P. Wevers
  • Melinda S. Schuurman
  • Harald J. Hoekstra



In the US, whether a sentinel lymph node biopsy (SLNB) is performed depends on tumor and patient factors, including socioeconomic status (SES) and type of health care insurance. We analyzed which patient and tumor characteristics influenced the use of SLNB in a country where every patient has equal access to healthcare.


Patients diagnosed with a cutaneous invasive melanoma of ≥1 mm between 2004 and 2011 and living in the northeastern part of the Netherlands were selected from the Netherlands Cancer Registry. Regression analysis was performed to assess the association of patient and tumor characteristics and SLNB use.


SLNB was performed in 42 % of the 2,413 included patients. The frequency of performing SLNB increased between 2004 and 2011 from 24 to 55 % (p < 0.001). Patients were less likely to undergo SLNB if they had a melanoma located in the head and neck area (p < 0.001), when they were over 55 years (p = 0.001), and if they had a low SES (p = 0.03). SLNB use was more likely when the diagnosis of melanoma was made in the university hospital (p = 0.045) or when the Breslow thickness was 2.01–4.0 mm (p = 0.03).


The use of SLNB has increased significantly between 2004 and 2011. However, in 2011 it was still performed in only 55 % of the Dutch patients with a melanoma ≥1 mm. In patients with head and neck melanoma, older patients, and patients with low SES, SLNB was less frequently performed. Patients with T3 melanomas and a diagnosis made in the university hospital more often had an SLNB performed.


Melanoma Sentinel Lymph Node Biopsy Academic Hospital Neck Area Breslow Thickness 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest

No commercial interests to disclose.


  1. 1.
    Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127:392–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Gershenwald JE, Thompson W, Mansfield PF, et al. Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients. J Clin Oncol. 1999;17:976–83.PubMedGoogle Scholar
  3. 3.
    Cascinelli N, Bombardieri E, Bufalino R, et al. Sentinel and nonsentinel node status in stage IB and II melanoma patients: two-step prognostic indicators of survival. J Clin Oncol. 2006;24:4464–71.PubMedCrossRefGoogle Scholar
  4. 4.
    Kettlewell S, Moyes C, Bray C, et al. Value of sentinel node status as a prognostic factor in melanoma: prospective observational study. BMJ. 2006;332:1423–8.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Chao C, Wong SL, Ross MI, et al. Patterns of early recurrence after sentinel lymph node biopsy for melanoma. Am J Surg. 2002;184:520–4; discussion 525.Google Scholar
  6. 6.
    Morton DL, Thompson JF, Cochran AJ, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355:1307–17.PubMedCrossRefGoogle Scholar
  7. 7.
    Morton DL, Thompson JF, Cochran AJ, et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med. 2014;370:599–609.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Balch CM, Gershenwald JE, Soong SJ, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27:6199–206.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Balch CM, Soong SJ, Gershenwald JE, et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol. 2001;19:3622–34.PubMedGoogle Scholar
  10. 10.
    van Everdingen JJ, van der Rhee HJ, Koning CC, et al. Guideline ‘Melanoma’ (3rd revision). Ned Tijdschr Geneeskd. 2005;149:1839–43.PubMedGoogle Scholar
  11. 11.
    Veerbeek L, Kruit WH, de Wilt J, Mooi WJ, Bergman W. Revision of the national guideline ‘Melanoma’. Ned Tijdschr Geneeskd. 2013;157:A6136.PubMedGoogle Scholar
  12. 12.
    Cormier JN, Xing Y, Ding M, et al. Population-based assessment of surgical treatment trends for patients with melanoma in the era of sentinel lymph node biopsy. J Clin Oncol. 2005;23:6054–62.PubMedCrossRefGoogle Scholar
  13. 13.
    Wasif N, Gray RJ, Bagaria SP, Pockaj BA. Compliance with guidelines in the surgical management of cutaneous melanoma across the USA. Melanoma Res. 2013;23:276–82.PubMedGoogle Scholar
  14. 14.
    Bilimoria KY, Balch CM, Wayne JD, et al. Health care system and socioeconomic factors associated with variance in use of sentinel lymph node biopsy for melanoma in the United States. J Clin Oncol. 2009;27:1857–63.PubMedCrossRefGoogle Scholar
  15. 15.
    Martinez SR, Shah DR, Maverakis E, Yang AD. Geographic variation in utilization of sentinel lymph node biopsy for intermediate thickness cutaneous melanoma. J Surg Oncol. 2012;106:807–10.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Stitzenberg KB, Thomas NE, Beskow LM, Ollila DW. Population-based analysis of lymphatic mapping and sentinel lymphadenectomy utilization for intermediate thickness melanoma. J Surg Oncol. 2006;93:100–7; discussion 107–8.Google Scholar
  17. 17.
    Lens MB, Dawes M, Newton-Bishop JA, Goodacre T. Management of regional lymph nodes in patients with malignant melanoma: questionnaire survey of UK current practice. Br J Plast Surg. 2002;55:372–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Grange F, Vitry F, Granel-Brocard F, et al. Variations in management of stage I to stage III cutaneous melanoma: a population-based study of clinical practices in France. Arch Dermatol. 2008;144:629–36.PubMedCrossRefGoogle Scholar
  19. 19.
    Livingstone E, Windemuth-Kieselbach C, Eigentler TK, et al. A first prospective population-based analysis investigating the actual practice of melanoma diagnosis, treatment and follow-up. Eur J Cancer. 2011;47:1977–89.PubMedCrossRefGoogle Scholar
  20. 20.
    Wong SL, Balch CM, Hurley P, et al. Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology joint clinical practice guideline. Ann Surg Oncol. 2012;19:3313–24.PubMedCrossRefGoogle Scholar
  21. 21.
    Leong SP. Role of selective sentinel lymph node dissection in head and neck melanoma. J Surg Oncol. 2011;104:361–8.PubMedCrossRefGoogle Scholar
  22. 22.
    de Rosa N, Lyman GH, Silbermins D, et al. Sentinel node biopsy for head and neck melanoma: a systematic review. Otolaryngol Head Neck Surg. 2011;145:375–82.PubMedCrossRefGoogle Scholar
  23. 23.
    Carlson GW, Murray DR, Greenlee R, et al. Management of malignant melanoma of the head and neck using dynamic lymphoscintigraphy and gamma probe-guided sentinel lymph node biopsy. Arch Otolaryngol Head Neck Surg. 2000;126:433–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Tanis PJ, Nieweg OE, van den Brekel MW, Balm AJ. Dilemma of clinically node-negative head and neck melanoma: outcome of “watch and wait” policy, elective lymph node dissection, and sentinel node biopsy—a systematic review. Head Neck. 2008;30:380–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Havenga K, Cobben DC, Oyen WJ, et al. Fluorodeoxyglucose-positron emission tomography and sentinel lymph node biopsy in staging primary cutaneous melanoma. Eur J Surg Oncol. 2003;29:662–4.PubMedCrossRefGoogle Scholar
  26. 26.
    Stoffels I, Boy C, Poppel T, et al. Association between sentinel lymph node excision with or without preoperative SPECT/CT and metastatic node detection and disease-free survival in melanoma. JAMA. 2012;308:1007–14.PubMedCrossRefGoogle Scholar
  27. 27.
    Kretschmer L, Altenvoerde G, Meller J, et al. Dynamic lymphoscintigraphy and image fusion of SPECT and pelvic CT-scans allow mapping of aberrant pelvic sentinel lymph nodes in malignant melanoma. Eur J Cancer. 2003;39:175–83.PubMedCrossRefGoogle Scholar
  28. 28.
    van der Ploeg IM, Valdes Olmos RA, Kroon BB, Nieweg OE. Tumor-positive sentinel node biopsy of the groin in clinically node-negative melanoma patients: superficial or superficial and deep lymph node dissection? Ann Surg Oncol. 2008;15:1485–91.PubMedCrossRefGoogle Scholar
  29. 29.
    Rbah-Vidal L, Vidal A, Besse S, et al. Early detection and longitudinal monitoring of experimental primary and disseminated melanoma using [(1)(0)F]ICF01006, a highly promising melanoma PET tracer. Eur J Nucl Med Mol Imaging. 2012;39:1449–61.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Anna M. Huismans
    • 1
    • 2
  • Maarten G. Niebling
    • 1
  • Kevin P. Wevers
    • 1
  • Melinda S. Schuurman
    • 3
  • Harald J. Hoekstra
    • 1
  1. 1.Department of Surgical OncologyUniversity Medical Centre GroningenGroningenThe Netherlands
  2. 2.Department of Internal MedicineDiakonessenhuisUtrechtThe Netherlands
  3. 3.Department of ResearchComprehensive Cancer Centre the Netherlands (IKNL)AmsterdamThe Netherlands

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