Improving Risk Stratification for SLNB in Elderly Patients With Melanoma: The SENTINOLD Nomogram
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Sentinel lymph node biopsy (SLNB) is one of the strongest prognostic indicators to date for cutaneous melanoma. However, its indication in elderly patients is controversial due to lower prognostic benefits, comorbidities, and surgical risks. OBJECTIVES: The aim of this study was to develop and validate a predictive model specifically tailored to patients aged ≥ 75 years with cutaneous melanoma, and to compare its performance with the Melanoma Institute Australia (MIA) and Memorial Sloan Kettering Cancer Center (MSKCC) calculators. METHODS: A multicenter, retrospective cohort study (SENTINOLD) including 795 patients aged ≥ 75 years was conducted across seven Spanish hospitals, representing one of the largest European datasets of elderly melanoma patients. A multivariable logistic regression model was developed using 12 clinicopathologic variables. Model performance was assessed by discrimination (AUC), calibration, and decision curve analysis (DCA), and compared with MIA and MSKCC calculators. Temporal validation was performed using a hold-out dataset representing the most recent diagnoses. RESULTS: The SENTINOLD nomogram demonstrated robust discrimination (AUC = 0.71), outperforming the MSKCC (0.66) and MIA (0.64) models (p < 0.05). Calibration and decision curve analysis confirmed greater clinical usefulness within the 5%-20% decision threshold range. Temporal validation showed stable performance (AUC = 0.68; Brier = 0.187). An interactive web-based calculator is freely available at https://sentinold.netlify.app, allowing clinicians to estimate the risk of SLN positivity using key tumor and patient characteristics. CONCLUSIONS: The SENTINOLD nomogram provides a reliable, user-friendly, and population-specific tool for individualized prediction of sentinel lymph node positivity in elderly melanoma patients. Its use may assist clinicians in guiding SLNB decision-making in this age group, although independent external validation and prospective evaluation of clinical impact are warranted.
DOI: 10.1111/ijd.70413
Authors: Nieves Martínez Campayo, Sabela Paradela de la Morena, Sebastian Podlipnik, Susana Puig, Josep Malvehy, Cristina Carrera, Eduardo Nagore, Ruggero Moro, Aram Boada, Nina Richarz, Pedro Rodríguez‐Jiménez, Pablo Bonete, Clara Buendía‐Martínez, Blanca de Unamuno, Rafael Botella‐Estrada, Pablo Fernández‐Fernández, Javier Cañueto, Juan Ignacio Bugallo Sanz, Oihane García‐Senosiain, Eduardo Fonseca, Antonio Tejera Vaquerizo
Institutions: Complexo Hospitalario Universitario A Coruña, Instituto de Salud Carlos III, Hospital Clínic de Barcelona, Consorci Institut D'Investigacions Biomediques August Pi I Sunyer, Universitat de Barcelona, Fundación Instituto Valenciano de Oncología, Universitat Autònoma de Barcelona, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Hospital Universitari Germans Trias i Pujol, Hospital Universitario de La Princesa, Universitat de València, Hospital Universitari i Politècnic La Fe, Instituto de Investigación Sanitaria La Fe, Complejo Hospitalario de Salamanca, Hospital San Juan de Dios
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7153829581