P080 Evaluating the role of frailty scores in determining indication for sentinel lymph node biopsy in older patients with melanoma

Abstract

The prognostic and therapeutic benefits of sentinel lymph node biopsy (SLNBx) in older patients with melanoma remain debated. Frailty is increasingly recognized as an important predictor of surgical and oncological risk. This study aims to examine the association between frailty and SLNBx-related management decisions within a plastic surgery service. A retrospective cohort study was conducted of patients aged ≥ 60 years diagnosed with melanoma stage ≥ T1b between January 2020 and December 2025 in a single tertiary hospital. Frailty was assessed using the Clinical Frailty Scale (CFS) preoperatively and > 6 weeks postoperatively. Primary outcomes included CFS scores, SLNBx histology and postoperative complications. In total 184 patients were included (median age 72 years, range 60–92). SLNBx was performed in 87.0% (n = 160), with 19.4% (n = 31) positive for melanoma. SLNBx utilization rates were 92.2% (94 of 102, CFS 1–3), 90% (56 of 62, CFS 4–5), and 55% (6 of 11, CFS ≥ 6). SLNBx complications occurred in 16.7% (n = 17), 19% (n = 12) and 9% (n = 1) of these groups, respectively. Median CFS increased with tumour stage, ranging from ‘3: managing well’ in pT1a to ‘4: vulnerable’ in pT4b, with similar postoperative trends. Overall, frailty worsened postoperatively in 16.3% (n = 30), affecting 15.7% (n = 16) of those with CFS 1–3, 16% (n = 10) with CFS 4–5 and 27% (n = 3) with CFS ≥ 6. In conclusion, frail patients, particularly those with CFS ≥ 6, were less likely to be offered SLNBx. Postoperative deterioration in frailty was more common in higher-risk groups despite comparable complication rates. Routine frailty assessment may support surgical decision making for older patients with melanoma.