The Impact of Smoking on Sentinel Node Metastasis of Primary Cutaneous Melanoma

Maris S. Jones, Peter C. Jones, Stacey L. Stern, David Elashoff, Dave S.B. Hoon, John Thompson, Nicola Mozzillo, Omgo E. Nieweg, Dirk Noyes, Harald J. Hoekstra, Jonathan S. Zager, Daniel F. Roses, Alessandro Testori, Brendon J. Coventry, Mark B. Smithers, Robert Andtbacka, Doreen Agnese, Erwin Schultz, Eddy C. Hsueh, Mark KelleySchlomo Schneebaum, Lisa Jacobs, Tawnya Bowles, Mohammed Kashani-Sabet, Douglas Johnson, Mark B. Faries

Research output: Contribution to journalArticlepeer-review


Background: Although a well-established causative relationship exists between smoking and several epithelial cancers, the association of smoking with metastatic progression in melanoma is not well studied. We hypothesized that smokers would be at increased risk for melanoma metastasis as assessed by sentinel lymph node (SLN) biopsy. Methods: Data from the first international Multicenter Selective Lymphadenectomy Trial (MSLT-I) and the screening-phase of the second trial (MSLT-II) were analyzed to determine the association of smoking with clinicopathologic variables and SLN metastasis. Results: Current smoking was strongly associated with SLN metastasis (p = 0.004), even after adjusting for other predictors of metastasis. Among 4231 patients (1025 in MSLT-I and 3206 in MSLT-II), current or former smoking was also independently associated with ulceration (p < 0.001 and p < 0.001, respectively). Compared with current smoking, never smoking was independently associated with decreased Breslow thickness in multivariate analysis (p = 0.002) and with a 0.25 mm predicted decrease in thickness. Conclusion: The direct correlation between current smoking and SLN metastasis of primary cutaneous melanoma was independent of its correlation with tumor thickness and ulceration. Smoking cessation should be strongly encouraged among patients with or at risk for melanoma.

Original languageEnglish (US)
Pages (from-to)2089-2094
Number of pages6
JournalAnnals of surgical oncology
Issue number8
StatePublished - Aug 1 2017

ASJC Scopus subject areas

  • Surgery
  • Oncology


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