Sentinel Lymph Node Predictors in Melanoma of Breslow Thickness 0.8-1.0 mm
Main Article Content
Keywords
thin melanoma
Abstract
Introduction: Current melanoma staging guidelines consider all patients staged T1b to have the same metastatic risk and recommends that sentinel lymph node biopsy (SLNB) be considered in this disparate group. The goals of this study were to specifically determine predictors of sentinel lymph node positivity and those predictive for obtaining a SLNB in melanomas of Breslow thickness 0.8 mm to 1.0 mm, which has not been previously studied.
Methods: Retrospective review between January 1997 and July 2019 of patients with melanomas between 0.8 mm-1.0 mm in thickness. Patient demographics and primary tumor characteristics were correlated with SLN status.
Results: Of the 458 patients found to meet Breslow thickness criteria, 223 (61.8%) underwent SLNB. Multivariate analyses demonstrated that < 60 years of age (OR 2.42), increasing Breslow thickness (OR 1.27), mitotic rate >1 (OR 2.32) and presence of tumor infiltrating lymphocytes (OR 3.33), were associated with performing a SLNB. Positive SLNB was found in 20 (8.1 %). Univariate analyses revealed females (p=0.016) to have an increased risk for positive SLNB.
Limitations: Limited number of positive SLN and survival data available.
Conclusions: Younger age, Breslow thickness ≥0.9 mm, mitotic rate >1, and presence of tumor infiltrative lymphocytes were found to be factors predictive of performing SLNB. Female gender significantly increased the odds of a positive SLN.
References
2. Andtbacka RH, Gershenwald JE. Role of sentinel lymph node biopsy in patients with thin melanoma. J Natl Compr Canc Netw. 2009 Mar;7(3):308-17.
3. National Comprehensive Cancer Network. Cutaneous Melanoma (Version 3.2020). https://www.nccn.org/professionals/physician_gls/pdf/cutaneous_melanoma.pdf. Accessed June 17, 2020.
4. Yonick DV, Ballo RM, Kahn E, et al. Predictors of positive sentinel lymph node in thin melanoma. Am J Surg. 2011 Mar;201(3):324-7
5. Munsch C, Lauwers-Cances V, Lamant L, et al. Breslow thickness, clark index and ulceration are associated with sentinel lymph node metastasis in melanoma patients: a cohort analysis of 612 patients. Dermatology. 2014;229(3):183-9.
6. Cavanaugh-Hussey MW, Mu EW, Kang S, et al. Older Age is Associated with a Higher Incidence of Melanoma Death but a Lower Incidence of Sentinel Lymph Node Metastasis in the SEER Databases (2003-2011). Ann Surg Oncol. 2015 Jul;22(7):2120-6.
7. Han D, Zager JS, Shyr Y, et al. Clinicopathologic predictors of sentinel lymph node metastasis in thin melanoma. J Clin Oncol. 2013 Dec 10;31(35):4387-93.
8. Cordeiro E, Gervais M, Shah PS, et al. Sentinel Lymph Node Biopsy in Thin Cutaneous Melanoma: A Systematic Review and Meta-Analysis. Ann Surg Oncol. 2016; 23:4178–4188.
9. Conic RRZ, Ko J, Damiani G. Predictors of sentinel lymph nodepositivity in thin melanoma using the National Cancer Database. J Am Acad Dermatol. 2019;80:441-7.
10. Wright BE, Scheri RP, Ye X, et al. Importance of sentinel lymph node biopsy in patients withthin melanoma. Arch Surg. 2008 Sep;143(9):892-9.
11. Venna SS, Thummala S, Nosrati M, et al. Analysis of sentinel lymph node positivity in patients with thin primary melanoma. J Am Acad Dermatol. 2013;68:560-567.
12. Sondak VK, Taylor JM, Sabel MS, et al. Mitotic rate and younger age are predictors of sentinel lymph node positivity: Lessons learned from the generation of a probabilistic model. Ann Surg Oncol. 2004;11:247-258.
13. Khosrotehrani K, Dasgupta P, Byrom L, et al. Melanoma survival is superior in females across all tumor stages but is influenced by age. Arch Dermatol Res. 2015;307:731-40.
14. Taylor RC, Patel A, Panageas KS, et al. Tumor-Infiltrating Lymphocytes Predict Sentinel Lymph Node Positivity in Patients With Cutaneous Melanoma. J Clin Oncol. 2007;25:869-875.
15. Clark WH Jr, Elder DE, Guerry DT, et al. Model predicting survival in stage I melanoma based on tumor progression. J Natl Cancer Inst. 1989;81:1893-1904.
16. Clemente CG, Mihm MC Jr, Bufalino R, et al. Prognostic value of tumor infiltrating lymphocytes inthe vertical growth phase of primary cutaneous melanoma. Cancer. 1996;77:1303-1310.
17. Sondergaard K, Schou G: Survival with primary cutaneous malignant melanoma, evaluated from 2012 cases: A multivariate regression analysis. Virchows Arch A Pathol Anat Histopathol. 1985;406:179-195.
18. Johnson OK Jr, Emrich LJ, Karakousis CP, et al. Comparison of prognostic factors for survival and recurrence in malignant melanoma of the skin, clinical stage I. Cancer. 1985; 55:1107-1117.
19. Larsen TE, Grude TH: A retrospective histological study of 669 cases of primary cutaneous malignant melanoma in clinical stage I: The relation between the tumour-associated lymphocyte infiltration and age and sex, tumour cell type, pigmentation, cellular atypia, mitotic count, depth of invasion, ulceration, tumour type and prognosis. Acta Pathol Microbiol Scand. 1978;86A:523-530.
20. Barnhill RL, Fine JA, Roush GC, et al. Predicting five-year outcome for patients with cutaneous melanoma in a population-based study. Cancer. 1996;78: 427-432.
21. Thorn M, Ponten F, Bergstrom R, et al. Clinical and histopathologic predictors of survival in patients with malignant melanoma: A population based study in Sweden. J Natl Cancer Inst. 1994;86:761-769.
22. Kruper L, Botbyl B, Czerniecki B, et al. Sentinel lymph node status in stage II/III melanoma. J Clin Oncol. 2005;23:710S (suppl; abstr 7501).
23. Gimotty PA, Guerry D, Ming ME, et al. Thin primary cutaneous malignant melanoma: a prognostic tree for 10-year metastasis is more accurate than American Joint Committee on Cancer Staging. J Clin Oncol. 2004;22:3668–3676.
24. Mozzillo N, Pennacchhioli E, Gandini S, et al. Sentinel node biopsy in thin and thick melanoma. Ann Surg Oncol. 2013;20(8):2780–6.
25. Stitzenberg KB, Groben PA, Stern SL, et al. Indications for lymphatic mapping and sentinel lymphadenectomy in patients with thin melanoma (Breslow thickness B1.0 mm). Ann Surg Oncol. 2004;11(10): 900-6.
26. Ranieri JM, Wagner JD, Wenck S, et al. The prognostic importance of sentinel lymph node biopsy in thin melanoma. Ann Surg Oncol. 2006;13(7):927– 32.
27. Wong SL, Faries MB, Kennedy EB, et al. Results of sentinel lymph node biopsy in patients with thin melanoma. Ann Surg Oncol. 2006;13(3):302–9.
28. Cecchi R, Buralli L, Innocentu, De Gaudio C. Sentinel lymph node biopsy in patients with thin melanomas. J Dermatol. 2007;34(8):512–5.
29. Vermeeren L, Van der Ent, Sastrowijoto P, Hulsewe. Sentinel lymph node biopsy in patients with thin melanoma: occurrence of nodal metastases and its prognostic value. Eur J Dermatol. 2010;20(1):30–34.
30. Murali R, Haydu LE, Quinn MJ, et al. Sentinel lymph node biopsy in patients with thin primary cutaneous melanoma. Ann Surg. 2012;255(1):128–33.
31. Mitteldorf C, Bertsch HP, Jung K, et al. Sentinel node biopsy improves prognostic stratification in patients with thin (pT1) melanomas and an additional risk factor. Ann Surg Oncol. 2014;21(7):2252–8.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
Creative Commons Attribution (CC BY): lets others distribute and copy the article, to create extracts, abstracts, and other revised versions, adaptations or derivative works of or from an article (such as a translation), to include in a collective work (such as an anthology), to text or data mine the article, even for commercial purposes, as long as they credit the author(s), do not represent the author as endorsing their adaptation of the article, and do not modify the article in such a way as to damage the author's honor or reputation.
Authors retain copyright in their work and license the publisher to publish the content. The publisher is the National Society for Cutaneous Medicine, with production and publishing support provided by OJS, Open Journal Systems,see https://pkp.sfu.
Prior to January 2022, authors transferred copyright to the National Society for Cutaneous Medicine. However, all articles are freely available to anyone in the world. There are no subscription fees, page charges, or article processing charges.