Improving Risk Stratification for SLNB in Elderly Patients With Melanoma: The SENTINOLD Nomogram

Fecha de publicación: 01/01/2026 Fecha Ahead of Print: 01/04/2026

Autores de IIS La Fe

Rafael Botella Estrada

Autor

Participantes ajenos a IIS La Fe

Martínez Campayo N.
Paradela de la Morena S.
Podlipnik S.
Puig S.
Malvehy J.
Carrera C.
Nagore E.
Moro R.
Boada A.
Richarz N.
Rodríguez-Jiménez P.
Bonete P.
Buendía-Martínez C.
de Unamuno B.
Fernández-Fernández P.
Cañueto J.
Bugallo Sanz J.I.
García-Senosiain O.
Fonseca E.
Tejera Vaquerizo A.

Grupos

Dermatología y Regeneración Tisular

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. (Figure presented.). © 2026 the International Society of Dermatology.

Datos de la publicación

ISSN/ISSNe:: 0011-9059, 1365-4632
Tipo:: Article
Páginas:: 2108-2116
DOI:: 10.1111/ijd.70413
PubMed:: 41966754
Enlace a otro recurso:: www.scopus.com
Factor de Impacto:: 0,660 SCImago ℠
Cuartil:: Q2 SCImago ℠

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Filiaciones

Martínez Campayo N.:: Dermatology Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
Paradela de la Morena S.:: Dermatology Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
Podlipnik S.:: Dermatology Department, Hospital Clínic, IDIBAPS, University of Barcelona/CIBERER, Instituto de Salud Carlos III, Barcelona, Spain
Puig S.:: Dermatology Department, Hospital Clínic, IDIBAPS, University of Barcelona/CIBERER, Instituto de Salud Carlos III, Barcelona, Spain
Malvehy J.:: Dermatology Department, Hospital Clínic, IDIBAPS, University of Barcelona/CIBERER, Instituto de Salud Carlos III, Barcelona, Spain
Carrera C.:: Dermatology Department, Hospital Clínic, IDIBAPS, University of Barcelona/CIBERER, Instituto de Salud Carlos III, Barcelona, Spain
Nagore E.:: Dermatology Department, Instituto Valenciano de Oncología (IVO), Valencia, Spain
Moro R.:: Dermatology Department, Instituto Valenciano de Oncología (IVO), Valencia, Spain
Boada A.:: Dermatology Department, Hospital Universitari Germans Trias i Pujol/Institut D'investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
Richarz N.:: Dermatology Department, Hospital Universitari Germans Trias i Pujol/Institut D'investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
Rodríguez-Jiménez P.:: Dermatology Department, Hospital Universitario de La Princesa, Madrid, Spain
Bonete P.:: Dermatology Department, Hospital Universitario de La Princesa, Madrid, Spain
Buendía-Martínez C.:: Dermatology Department, Hospital Universitario de La Princesa, Madrid, Spain
de Unamuno B.:: Instituto de Investigación. Dermatology Department, Hospital Universitari i Politècnic La Fe/Instituto de Investigación Sanitaria La Fe (IIS La Fe) / Facultad de Medicina, Universidad de Valencia, Valencia, Spain
Botella-Estrada R.:: Instituto de Investigación. Dermatology Department, Hospital Universitari i Politècnic La Fe/Instituto de Investigación Sanitaria La Fe (IIS La Fe) / Facultad de Medicina, Universidad de Valencia, Valencia, Spain
Fernández-Fernández P.:: -Dermatology Department, Hospital Universitario de Salamanca, Salamanca, Spain
Cañueto J.:: -Dermatology Department, Hospital Universitario de Salamanca, Salamanca, Spain
Bugallo Sanz J.I.:: Plastic Surgery Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
García-Senosiain O.:: Plastic Surgery Department, Hospital Universitari Germans Trias i Pujol, Institut D'investigació Germans Trias i Pujol/Universitat Autònoma de Barcelona, Badalona, Spain
Fonseca E.:: Dermatology Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
Tejera Vaquerizo A.:: Dermatology Department, Instituto Dermatológico GlobalDerm, Córdoba, Spain

Cutaneous Oncology Unit, Hospital San Juan de Dios, Córdoba, Spain

Keywords

elderly patients; melanoma; nomogram; predictive model; risk stratification; sentinel lymph node biopsy

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