{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T14:36:43Z","timestamp":1769006203610,"version":"3.49.0"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2021,5,25]],"date-time":"2021-05-25T00:00:00Z","timestamp":1621900800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The Multicenter Selective Lymphadenectomy Trial (MSLT-1) comparing survival after a sentinel lymph node biopsy (SLNB) versus nodal observation in melanoma patients did not show a significant benefit favoring SLNB. However, in subgroup analyses melanoma-specific survival among patients with nodal metastases seemed better.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Aim<\/jats:title>\n<jats:p>To evaluate the association of performing a SLNB with overall survival in intermediate thickness melanoma patients in a Dutch population-based daily clinical setting.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Survival, excess mortality adjusted for age, gender, Breslow-thickness, ulceration, histological subtype, location, co-morbidity and socioeconomic status were calculated in a population of 1,989 patients diagnosed with malignant cutaneous melanoma (1.2\u20133.5 mm) on the trunk or limb between 2000\u20132016 in ten hospitals in the South East area, The Netherlands.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>A SLNB was performed in 51% of the patients (n = 1008). Ten-year overall survival after SLNB was 75% (95%CI, 71%-78%) compared to 61% (95%CI 57%-64%) following observation. After adjustment for risk factors, a lower risk on death (HR = 0.80, 95%CI 0.66\u20130.96) was found after SLNB compared to observation only.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>SLNB in patients with intermediate-thickness melanoma on trunk or limb resulted in a 14% absolute and significant 10-year survival difference compared to those without SLNB.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0252021","type":"journal-article","created":{"date-parts":[[2021,5,25]],"date-time":"2021-05-25T17:31:17Z","timestamp":1621963877000},"page":"e0252021","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Survival of sentinel node biopsy versus observation in intermediate-thickness melanoma: A Dutch population-based study"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0521-1985","authenticated-orcid":true,"given":"R. M. H.","family":"Roumen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. S.","family":"Schuurman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. J.","family":"Aarts","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. J. G.","family":"Maaskant-Braat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G.","family":"Vreugdenhil","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9011-6741","authenticated-orcid":true,"given":"W. J.","family":"Louwman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,5,25]]},"reference":[{"issue":"1","key":"pone.0252021.ref001","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1016\/j.jaad.2018.08.055","article-title":"Guidelines of care for the management of primary cutaneous melanoma","volume":"80","author":"SM Swetter","year":"2019","journal-title":"J Am Acad Dermatol"},{"issue":"Suppl 1","key":"pone.0252021.ref002","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1007\/s40257-018-0379-0","article-title":"Sentinel Lymph Node Biopsy: Past and Present Implications for the Management of Cutaneous Melanoma with Nodal Metastasis","volume":"19","author":"A Gonzalez","year":"2018","journal-title":"Am J Clin Dermatol"},{"issue":"7","key":"pone.0252021.ref003","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1056\/NEJMoa1310460","article-title":"Final trial report of sentinel-node biopsy versus nodal observation in melanoma","volume":"370","author":"DL Morton","year":"2014","journal-title":"N Engl J Med"},{"issue":"7","key":"pone.0252021.ref004","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1056\/NEJMe1313690","article-title":"Clinical value of the sentinel-node biopsy in primary cutaneous melanoma","volume":"370","author":"CM Balch","year":"2014","journal-title":"N Engl J Med"},{"issue":"3","key":"pone.0252021.ref005","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1111\/bjd.13666","article-title":"Sentinel node biopsy in cutaneous melanoma: time for consensus to better inform patient choice","volume":"172","author":"JM McGregor","year":"2015","journal-title":"Br J Dermatol"},{"key":"pone.0252021.ref006","doi-asserted-by":"crossref","first-page":"e8645","DOI":"10.1136\/bmj.e8645","article-title":"Sentinel node biopsy for melanoma: unnecessary treatment?","volume":"346","author":"I Torjesen","year":"2013","journal-title":"BMJ"},{"issue":"5\u20136","key":"pone.0252021.ref007","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1007\/s10585-018-9898-6","article-title":"Lymph node metastasis in melanoma: a debate on the significance of nodal metastases, conditional survival analysis and clinical trials","volume":"35","author":"MB Faries","year":"2018","journal-title":"Clin Exp Metastasis"},{"issue":"1","key":"pone.0252021.ref008","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/bjd.17143","article-title":"Recent developments in lymph node surgery for melanoma","volume":"180","author":"ACJ van Akkooi","year":"2019","journal-title":"Br J Dermatol"},{"key":"pone.0252021.ref009","unstructured":"Oncoline 2012 [cited 2019 june 03]. Available from: https:\/\/www.oncoline.nl."},{"issue":"12","key":"pone.0252021.ref010","first-page":"A6136","article-title":"[Revision of the national guideline \u2019Melanoma\u2019]","volume":"157","author":"L Veerbeek","year":"2013","journal-title":"Ned Tijdschr Geneeskd"},{"key":"pone.0252021.ref011","unstructured":"Oncoline 2016 [cited 2019 june 03]. Available from: https:\/\/www.oncoline.nl\/melanoom."},{"issue":"11","key":"pone.0252021.ref012","doi-asserted-by":"crossref","first-page":"3395","DOI":"10.1245\/s10434-014-3764-9","article-title":"Factors influencing the use of sentinel lymph node biopsy in the Netherlands","volume":"21","author":"AM Huismans","year":"2014","journal-title":"Ann Surg Oncol"},{"issue":"3","key":"pone.0252021.ref013","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1093\/ije\/22.3.369","article-title":"Completeness of cancer registration in Limburg, The Netherlands","volume":"22","author":"LJ Schouten","year":"1993","journal-title":"Int J Epidemiol."},{"key":"pone.0252021.ref014","volume-title":"Cancer IUA","author":"LH Sobin","year":"2012","edition":"6"},{"key":"pone.0252021.ref015","unstructured":"WorldHealthOrganization. International Classification of Diseases for Oncology (ICD-O). 3 ed. Geneva2000."},{"issue":"5","key":"pone.0252021.ref016","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"ME Charlson","year":"1987","journal-title":"J Chronic Dis"},{"key":"pone.0252021.ref017","first-page":"32","article-title":"Sociaal-economische status indicator op postcodeniveau","volume":"50","author":"C Van Duin","year":"2002","journal-title":"Maandstatistiek van de bevolking"},{"issue":"7","key":"pone.0252021.ref018","doi-asserted-by":"crossref","first-page":"2112","DOI":"10.1245\/s10434-015-4539-7","article-title":"Sentinel Lymph Node Biopsy Use Among Melanoma Patients 75 Years of Age and Older","volume":"22","author":"MS Sabel","year":"2015","journal-title":"Ann Surg Oncol"},{"issue":"3","key":"pone.0252021.ref019","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1002\/hed.20749","article-title":"Dilemma of clinically node-negative head and neck melanoma: outcome of \"watch and wait\" policy, elective lymph node dissection, and sentinel node biopsy\u2014a systematic review","volume":"30","author":"PJ Tanis","year":"2008","journal-title":"Head Neck"},{"issue":"3","key":"pone.0252021.ref020","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1007\/s10147-012-0399-3","article-title":"Sentinel lymph node biopsy for cutaneous melanoma: results of 10 years\u2019 experience in two regional training hospitals in the Netherlands","volume":"18","author":"FJ van den Broek","year":"2013","journal-title":"Int J Clin Oncol"},{"issue":"6","key":"pone.0252021.ref021","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/S1470-2045(16)00141-8","article-title":"Complete lymph node dissection versus no dissection in patients with sentinel lymph node biopsy positive melanoma (DeCOG-SLT): a multicentre, randomised, phase 3 trial","volume":"17","author":"U Leiter","year":"2016","journal-title":"Lancet Oncol"},{"issue":"29","key":"pone.0252021.ref022","doi-asserted-by":"crossref","first-page":"45671","DOI":"10.18632\/oncotarget.10140","article-title":"Prognostic role of sentinel lymph node biopsy for patients with cutaneous melanoma: A retrospective study of surveillance, epidemiology, and end-result population-based data","volume":"7","author":"J Chen","year":"2016","journal-title":"Oncotarget"},{"issue":"4","key":"pone.0252021.ref023","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1245\/s10434-018-6348-2","article-title":"Predictors for Use of Sentinel Node Biopsy and the Association with Improved Survival in Melanoma Patients Who Have Nodal Staging","volume":"25","author":"TD Murtha","year":"2018","journal-title":"Ann Surg Oncol"},{"key":"pone.0252021.ref024","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.ejca.2016.02.029","article-title":"Prognostic instrument for survival outcome in melanoma patients: based on data from the population-based Swedish Melanoma Register","volume":"59","author":"J Lyth","year":"2016","journal-title":"Eur J Cancer"},{"issue":"1","key":"pone.0252021.ref025","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1159\/000078580","article-title":"Is sentinel lymph node biopsy of therapeutic relevance for melanoma?","volume":"209","author":"M Mohrle","year":"2004","journal-title":"Dermatology"},{"issue":"2","key":"pone.0252021.ref026","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1245\/s10434-010-1318-3","article-title":"Sentinel node dissection delays recurrence and prolongs melanoma-related survival: an analysis of 673 patients from a single center with long-term follow-up","volume":"18","author":"I Satzger","year":"2011","journal-title":"Ann Surg Oncol"},{"issue":"1","key":"pone.0252021.ref027","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1097\/SLA.0000000000000500","article-title":"Outcome following sentinel node biopsy plus wide local excision versus wide local excision only for primary cutaneous melanoma: analysis of 5840 patients treated at a single institution","volume":"260","author":"AP van der Ploeg","year":"2014","journal-title":"Ann Surg"},{"issue":"6","key":"pone.0252021.ref028","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1016\/j.jpedsurg.2016.02.067","article-title":"Sentinel lymph node biopsy is a prognostic measure in pediatric melanoma","volume":"51","author":"J Kim","year":"2016","journal-title":"J Pediatr Surg"},{"issue":"5","key":"pone.0252021.ref029","doi-asserted-by":"crossref","first-page":"1032","DOI":"10.1016\/j.jaad.2011.04.031","article-title":"Guidelines of care for the management of primary cutaneous melanoma. American Academy of Dermatology","volume":"65","author":"CK Bichakjian","year":"2011","journal-title":"J Am Acad Dermatol"},{"issue":"2","key":"pone.0252021.ref030","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1111\/j.1365-2133.2010.09883.x","article-title":"Revised U.K. guidelines for the management of cutaneous melanoma 2010","volume":"163","author":"JR Marsden","year":"2010","journal-title":"Br J Dermatol"},{"issue":"11","key":"pone.0252021.ref031","doi-asserted-by":"crossref","first-page":"1857","DOI":"10.1200\/JCO.2008.18.7567","article-title":"Health care system and socioeconomic factors associated with variance in use of sentinel lymph node biopsy for melanoma in the United States","volume":"27","author":"KY Bilimoria","year":"2009","journal-title":"J Clin Oncol"},{"issue":"7","key":"pone.0252021.ref032","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1002\/jso.23169","article-title":"Geographic variation in utilization of sentinel lymph node biopsy for intermediate thickness cutaneous melanoma","volume":"106","author":"SR Martinez","year":"2012","journal-title":"J Surg Oncol"},{"issue":"5","key":"pone.0252021.ref033","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1001\/archderm.144.5.629","article-title":"Variations in management of stage I to stage III cutaneous melanoma: a population-based study of clinical practices in France","volume":"144","author":"F Grange","year":"2008","journal-title":"Arch Dermatol"},{"issue":"1","key":"pone.0252021.ref034","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1245\/s10434-016-5460-4","article-title":"Population-Based Analysis of Completion Lymphadenectomy in Intermediate-Thickness Melanoma","volume":"24","author":"C Mosquera","year":"2017","journal-title":"Ann Surg Oncol"},{"issue":"2","key":"pone.0252021.ref035","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1002\/jso.23981","article-title":"A population-based assessment of melanoma: Does treatment in a regional cancer center make a difference?","volume":"112","author":"J Rivard","year":"2015","journal-title":"J Surg Oncol."},{"issue":"4","key":"pone.0252021.ref036","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.suronc.2017.08.006","article-title":"Practice variation in Sentinel Lymph Node Biopsy for melanoma patients in different geographical regions in the Netherlands","volume":"26","author":"J Verstijnen","year":"2017","journal-title":"Surg Oncol."},{"issue":"12","key":"pone.0252021.ref037","doi-asserted-by":"crossref","first-page":"2705","DOI":"10.1016\/j.ejca.2013.03.013","article-title":"Low level of education is associated with later stage at diagnosis and reduced survival in cutaneous malignant melanoma: a nationwide population-based study in Sweden","volume":"49","author":"H Eriksson","year":"2013","journal-title":"Eur J Cancer"},{"issue":"2","key":"pone.0252021.ref038","doi-asserted-by":"crossref","first-page":"113","DOI":"10.4065\/mcp.2010.0671","article-title":"Association of socioeconomic status with Breslow thickness and disease-free and overall survival in stage I-II primary cutaneous melanoma","volume":"86","author":"M Mandala","year":"2011","journal-title":"Mayo Clin Proc"},{"issue":"13","key":"pone.0252021.ref039","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1056\/NEJMoa060992","article-title":"Sentinel-node biopsy or nodal observation in melanoma","volume":"355","author":"DL Morton","year":"2006","journal-title":"N Engl J Med"},{"issue":"1","key":"pone.0252021.ref040","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.ejca.2013.08.023","article-title":"The prognostic significance of sentinel node tumour burden in melanoma patients: an international, multicenter study of 1539 sentinel node-positive melanoma patients","volume":"50","author":"AP van der Ploeg","year":"2014","journal-title":"Eur J Cancer"},{"issue":"12","key":"pone.0252021.ref041","doi-asserted-by":"crossref","first-page":"3300","DOI":"10.1245\/s10434-011-1741-0","article-title":"Therapeutic surgical management of palpable melanoma groin metastases: superficial or combined superficial and deep groin lymph node dissection","volume":"18","author":"AP van der Ploeg","year":"2011","journal-title":"Ann Surg Oncol"},{"issue":"3","key":"pone.0252021.ref042","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/S0895-4356(00)00305-X","article-title":"Are randomized clinical trials good for us (in the short term)? Evidence for a \"trial effect\"","volume":"54","author":"DA Braunholtz","year":"2001","journal-title":"J Clin Epidemiol"},{"issue":"3","key":"pone.0252021.ref043","first-page":"MR000009","article-title":"Outcomes of patients who participate in randomized controlled trials compared to similar patients receiving similar interventions who do not participate","author":"GE Vist","year":"2008","journal-title":"Cochrane Database Syst Rev"},{"issue":"23","key":"pone.0252021.ref044","doi-asserted-by":"crossref","first-page":"2211","DOI":"10.1056\/NEJMoa1613210","article-title":"Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma","volume":"376","author":"MB Faries","year":"2017","journal-title":"N Engl J Med"},{"issue":"12","key":"pone.0252021.ref045","doi-asserted-by":"crossref","first-page":"3330","DOI":"10.1245\/s10434-010-1208-8","article-title":"The prognostic significance of nonsentinel lymph node metastasis in melanoma","volume":"17","author":"RE Brown","year":"2010","journal-title":"Ann Surg Oncol"},{"issue":"9","key":"pone.0252021.ref046","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1001\/jamasurg.2013.3044","article-title":"Staging of regional lymph nodes in melanoma: a case for including nonsentinel lymph node positivity in the American Joint Committee on Cancer staging system","volume":"148","author":"AM Leung","year":"2013","journal-title":"JAMA Surg"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0252021","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,25]],"date-time":"2021-05-25T17:31:51Z","timestamp":1621963911000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0252021"}},"subtitle":[],"editor":[{"given":"Anna","family":"Sapino","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,5,25]]},"references-count":46,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5,25]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0252021","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,25]]}}}