The decision not to perform sentinel lymph node biopsy can be based on significant patient comorbidities, patient preference, or other factors.
An unresolved question is whether or not sentinel lymph node biopsy is a valid staging technique in older patients. "Older age is associated with worse prognosis, but lower rates of sentinel lymph node positivity," Dr. Swetter said. "The question is, why? One issue is whether there is different biology of melanoma in the elderly, or whether host immune factors come into play. Another [factor] could be delayed lymphatic spread, or it might be that tumors are more likely to disseminate hematogenously in older patients, compared with younger patients."
In the future, Dr. Swetter predicted the emergence of individualized prognoses based on novel weighted mathematical equations using AJCC staging and other factors. A Web-based predictive tool for prognosis developed by the AJCC Melanoma Database is currently available at www.melanomaprognosis.org.
Dr. Swetter stated having no relevant financial conflicts to disclose.