Skip to main content

Advertisement

SpringerLink
Log in

Age as a Predictor of Sentinel Node Metastasis among Patients with Localized Melanoma: An Inverse Correlation of Melanoma Mortality and Incidence of Sentinel Node Metastasis Among Young and Old Patients

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

We have previously reported that older patients with clinical stage I and II primary cutaneous. Melanoma had lower survival rates compared to younger patients. We postulated that the incidence of nodal metastasis would therefore be higher among older melanoma patients.

Methods

The expanded American Joint Committee on Cancer melanoma staging database contains a cohort of 7,756 melanoma patients who presented without clinical evidence of regional lymph node or distant metastasis and who underwent a sentinel node biopsy procedure as a component of their staging assessment.

Results

Although older patients had primary melanoma features associated with more aggressive biology, we paradoxically observed a significant decrease in the incidence of sentinel node metastasis as patient age increased. Overall, the highest incidence of sentinel node metastasis was 25.8 % in patients under 20 years of age, compared to 15.5 % in patients 80 years and older (p < 0.001). In contrast, 5-year mortality rates for clinical stage II patients ranged from a low of 20 % for those 20–40 years of age up to 38 % for those over 70 years of age. Patient age was an independent predictor of sentinel node metastasis in a multifactorial analysis (p < 0.001).

Conclusions

Patients with clinical stage I and II melanoma under 20 years of age had a higher incidence of sentinel lymph node metastasis but, paradoxically, a more favorable survival outcome compared to all other age groups. In contrast, patients >70 years had the most aggressive primary melanoma features and a higher mortality rate compared to all other age groups but a lower incidence of sentinel lymph node metastasis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Balch CM, Gershenwald JE, Soong SJ, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27:6199–206.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Balch CM, Gershenwald JE, Soong SJ, et al. Multivariate analysis of prognostic factors among 2,313 patients with stage III melanoma: comparison of nodal micrometastases versus macrometastases. J Clin Oncol. 2010;28:2452–9.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Balch CM, Soong SJ, Gershenwald JE, et al. Age as a prognostic factor in patients with localized melanoma and regional metastases. Ann Surg Oncol. 2013; 20(12):3961–8.

    Article  PubMed  Google Scholar 

  4. Balch CM, Soong SJ, Gershenwald JE, et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol. 2001;19:3622–34.

    CAS  PubMed  Google Scholar 

  5. Balch CM, Gershenwald, JE, Atkins, MB, et al. Melanoma of the skin. In: AJCC cancer staging manual, edited by SB. Edge, DR. Byrd, CC. Compton, et al. Edition. New York: Springer; 2009. pp. 325–44.

  6. Cox DR. Regression models and life-tables. J R Stat Soc B-Stat Methodol 1972;34:187–220.

    Google Scholar 

  7. Chao C, Martin II RC, Ross MI, et al. Correlation between prognostic factors and increasing age in melanoma. Ann Surg Oncol. 2004;11:259–64.

    Article  PubMed  Google Scholar 

  8. 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;11:247–58.

    Article  PubMed  Google Scholar 

  9. Balch CM, Soong SJ, Murad TM, et al. A multifactorial analysis of melanoma. II. Prognostic factors in patients with stage I (localized) melanoma. Surgery. 1979;86:343–51.

    CAS  PubMed  Google Scholar 

  10. Balch CM, Soong SJ, Murad TM, et al. A multifactorial analysis of melanoma: III. Prognostic factors in melanoma patients with lymph node metastases (stage II). Ann Surg. 1981;193:377–88.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Caraco C, Marone U, Botti G, et al. Age as predictor in patients with cutaneous melanoma submitted to sentinel lymph node biopsy. Eur J Surg Oncol. 2006;32:970–3.

    Article  CAS  PubMed  Google Scholar 

  12. Azimi F, Scolyer RA, Rumcheva P, et al. Tumor-infiltrating lymphocyte grade is an independent predictor of sentinel lymph node status and survival in patients with cutaneous melanoma. J Clin Oncol. 2012;30:2678–83.

    Article  PubMed  Google Scholar 

  13. Egger ME, Callender GG, McMasters KM, et al. Diversity of stage III melanoma in the era of sentinel lymph node biopsy. Ann Surg Oncol. 2013;20:956–63.

    Article  PubMed  Google Scholar 

  14. Kretschmer L, Starz H, Thoms KM, et al. Age as a key factor influencing metastasizing patterns and disease-specific survival after sentinel lymph node biopsy for cutaneous melanoma. Int J Cancer. 2011;129:1435–42.

    Article  CAS  PubMed  Google Scholar 

  15. McMasters KM, Wong SL, Edwards MJ, et al. Factors that predict the presence of sentinel lymph node metastasis in patients with melanoma. Surgery. 2001;130:151–6.

    Article  CAS  PubMed  Google Scholar 

  16. Niakosari F, Kahn HJ, McCready D, et al. Lymphatic invasion identified by monoclonal antibody D2–40, younger age, and ulceration: predictors of sentinel lymph node involvement in primary cutaneous melanoma. Arch Dermatol. 2008;144:462–7.

    Article  PubMed  Google Scholar 

  17. Rousseau DL Jr, Ross MI, Johnson MM, et al. Revised American Joint Committee on Cancer staging criteria accurately predict sentinel lymph node positivity in clinically node-negative melanoma patients. Ann Surg Oncol. 2003;10:569–74.

    Article  PubMed  Google Scholar 

  18. Sassen S, Shaw HM, Colman MH, et al. The complex relationships between sentinel node positivity, patient age, and primary tumor desmoplasia: analysis of 2,303 melanoma patients treated at a single center. Ann Surg Oncol. 2008;15:630–7.

    Article  PubMed  Google Scholar 

  19. Austin PF, Cruse CW, Lyman G, et al. Age as a prognostic factor in the malignant melanoma population. Ann Surg Oncol. 1994;1:487–94.

    Article  CAS  PubMed  Google Scholar 

  20. Thompson JF, Shaw HM. Should tumor mitotic rate and patient age, as well as tumor thickness, be used to select melanoma patients for sentinel node biopsy? Ann Surg Oncol. 2004;11:233–5.

    Article  PubMed  Google Scholar 

  21. 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;68:560–7.

    Article  PubMed  Google Scholar 

  22. White RL Jr, Ayers GD, Stell VH, et al. Factors predictive of the status of sentinel lymph nodes in melanoma patients from a large multicenter database. Ann Surg Oncol. 2011;18:3593–600.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Ciocan D, Barbe C, Aubin F, et al. Distinctive features of melanoma and its management in elderly patients: a population-based study in france. JAMA Dermatol. 2013;149:1150–7.

    Article  PubMed  Google Scholar 

  24. Page AJ, Li A, Hestley A, et al. Increasing age is associated with worse prognostic factors and increased distant recurrences despite fewer sentinel lymph node positives in melanoma. Int J Surg Oncol. 2012;2012:456987.

    CAS  PubMed Central  PubMed  Google Scholar 

  25. Lasithiotakis KG, Petrakis IE, Garbe C. Cutaneous melanoma in the elderly: epidemiology, prognosis and treatment. Melanoma Res. 2010;20:163–70.

    PubMed  Google Scholar 

  26. Conway WC, Faries MB, Nicholl MB, et al. Age-related lymphatic dysfunction in melanoma patients. Ann Surg Oncol. 2009;16:1548–52.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Pan WR, Suami H, Taylor GI. Senile changes in human lymph nodes. Lymphat Res Biol. 2008;6:77–83.

    Article  PubMed  Google Scholar 

  28. Lange JR, Kang S, Balch CM. Melanoma in the older patient: measuring frailty as an index of survival. Ann Surg Oncol. 2011;18:3531–2.

    Article  PubMed  Google Scholar 

  29. Sabel MS, Lee J, Cai S, et al. Sarcopenia as a prognostic factor among patients with stage III melanoma. Ann Surg Oncol. 2011;18:3579–85.

    Article  PubMed  Google Scholar 

  30. Balch CM, Soong SJ, Smith T, et al. Long-term results of a prospective surgical trial comparing 2 cm vs 4 cm excision margins for 740 patients with 1–4 mm melanomas. Ann Surg Oncol. 2001;8:101–8.

    CAS  PubMed  Google Scholar 

  31. Eppsteiner RW, Swick BL, Milhem MM, et al. Sentinel node biopsy for head and neck desmoplastic melanoma: not a given. Otolaryngol Head Neck Surg. 2012;147:271–4.

    Article  PubMed  Google Scholar 

  32. Han D, Zager JS, Han G, et al. The unique clinical characteristics of melanoma diagnosed in children. Ann Surg Oncol. 2012;19:3888–95.

    Article  PubMed  Google Scholar 

  33. Mohebati A, Ganly I, Busam KJ, et al. The role of sentinel lymph node biopsy in the management of head and neck desmoplastic melanoma. Ann Surg Oncol. 2012;19:4307–13.

    Article  CAS  PubMed  Google Scholar 

  34. Fadaki N, Li R, Parrett B, et al. Is head and neck melanoma different from trunk and extremity melanomas with respect to sentinel lymph node status and clinical outcome? Ann Surg Oncol. 2013;20(9):3089–97.

    Article  PubMed  Google Scholar 

  35. Egger ME, McMasters KM, Callender GG, et al. Unique prognostic factors in acral lentiginous melanoma. Am J Surg. 2012;204(6):874–9; discussion 879–80.

    Article  PubMed  Google Scholar 

  36. Stoffels I, Boy C, Poppel T, et al. Association between sentinel lymph node excision with or without preoperative SPECT/CT and metastatic node detection and disease-free survival in melanoma. JAMA. 2012;308:1007–14.

    Article  CAS  PubMed  Google Scholar 

  37. Chagpar RB, Ross MI, Reintgen DS, et al. Factors associated with improved survival among young adult melanoma patients despite a greater incidence of sentinel lymph node metastasis. J Surg Res. 2007;143:164–8.

    Article  PubMed  Google Scholar 

  38. Howman-Giles R, Shaw HM, Scolyer RA, et al. Sentinel lymph node biopsy in pediatric and adolescent cutaneous melanoma patients. Ann Surg Oncol. 2010;17:138–43.

    Article  PubMed  Google Scholar 

  39. Mu E, Lange JR, Strouse JJ. Comparison of the use and results of sentinel lymph node biopsy in children and young adults with melanoma. Cancer. 2012;118:2700–7.

    Article  PubMed  Google Scholar 

  40. Berk DR, LaBuz E, Dadras SS, et al. Melanoma and melanocytic tumors of uncertain malignant potential in children, adolescents and young adults—the Stanford experience, 1995–2008. Pediatr Dermatol. 2010;27:244–54.

    Article  PubMed  Google Scholar 

  41. Busam KJ, Murali R, Pulitzer M, et al. Atypical spitzoid melanocytic tumors with positive sentinel lymph nodes in children and teenagers, and comparison with histologically unambiguous and lethal melanomas. Am J Surg Pathol. 2009;33:1386–95.

    Article  PubMed  Google Scholar 

  42. Ghazi B, Carlson GW, Murray DR, et al. Utility of lymph node assessment for atypical spitzoid melanocytic neoplasms. Ann Surg Oncol. 2010;17:2471–5.

    Article  PubMed  Google Scholar 

  43. Meyers MO, Yeh JJ, Deal AM, et al. Age and Breslow depth are associated with a positive sentinel lymph node in patients with cutaneous melanocytic tumors of uncertain malignant potential. J Am Coll Surg. 2010;211:744–8.

    Article  PubMed  Google Scholar 

  44. Mills OL, Marzban S, Zager JS, et al. Sentinel node biopsy in atypical melanocytic neoplasms in childhood: a single institution experience in 24 patients. J Cutan Pathol. 2012;39:331–6.

    Article  PubMed  Google Scholar 

  45. Paradela S, Fonseca E, Pita-Fernandez S, et al. Prognostic factors for melanoma in children and adolescents: a clinicopathologic, single-center study of 137 patients. Cancer. 2010;116:4334–44.

    Article  PubMed  Google Scholar 

  46. Antony FC, Sanclemente G, Shaikh H, et al. Pigment synthesizing melanoma (so-called animal type melanoma): a clinicopathological study of 14 cases of a poorly known distinctive variant of melanoma. Histopathology. 2006;48:754–62.

    Article  CAS  PubMed  Google Scholar 

  47. Curtin JA, Fridlyand J, Kageshita T, et al. Distinct sets of genetic alterations in melanoma. N Engl J Med. 2005;353:2135–47.

    Article  CAS  PubMed  Google Scholar 

  48. Jemal A, Saraiya M, Patel P, et al. Recent trends in cutaneous melanoma incidence and death rates in the United States, 1992–2006. J Am Acad Dermatol. 2011;65(5 Suppl 1):S17–25, e11–3.

    Google Scholar 

  49. Strouse JJ, Fears TR, Tucker MA, et al. Pediatric melanoma: risk factor and survival analysis of the surveillance, epidemiology and end results database. J Clin Oncol. 2005;23:4735–41.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

The work of the AJCC/UICC Melanoma Staging Committee was supported by a Grant from the AJCC and by Grants from the National Cancer Institute (P30 CA13148 at the University of Alabama at Birmingham and P50 CA93459 SPORE Grant in melanoma at The University of Texas M. D. Anderson Cancer Center in Houston, TX, USA). Three meetings held by the committee were partially supported by an unrestricted educational Grant from Schering-Plough (Kenilworth, NJ, USA).

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Charles M. Balch MD

  2. Melanoma Institute Australia, North Sydney, NSW, Australia

    John F. Thompson MD

  3. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jeffrey E. Gershenwald MD & Merrick I. Ross MD

  4. University of Alabama at Birmingham, Birmingham, AL, USA

    Seng-jaw Soong PhD & Shouluan Ding PhD

  5. Department of Surgery, University of Louisville, Louisville, KY, USA

    Kelly M. McMasters MD, PhD

  6. Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Daniel G. Coit MD

  7. Cancer Institute Gustave Roussy, Villejuif, France

    Alexander M. M. Eggermont MD

  8. Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA

    Phyllis A. Gimotty PhD

  9. Department of Dermatology, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA

    Timothy M. Johnson MD

  10. Division of Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    John M. Kirkwood MD

  11. Department of Surgery, California Pacific Medical Center and Research Institute, San Francisco, CA, USA

    Stanley P. Leong MD

  12. Department of Surgery, University of Washington, Seattle, WA, USA

    David R. Byrd MD

  13. Departments of Pathology and Laboratory Medicine and Surgery, UCLA School of Medicine, Los Angeles, CA, USA

    Alistair J. Cochran MD

  14. Department of Pathology, Dana-Farber Cancer Institute, Boston, MA, USA

    Martin C. Mihm Jr MD

  15. John Wayne Cancer Institute, Santa Monica, CA, USA

    Donald L. Morton MD

  16. Lombardi Comprehensive Cancer Center, Medstar Georgetown University Hospital, Washington, DC, USA

    Michael B. Atkins MD

  17. Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Keith T. Flaherty MD

  18. Division of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA

    Vernon K. Sondak MD

Authors
  1. Charles M. Balch MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John F. Thompson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jeffrey E. Gershenwald MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Seng-jaw Soong PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shouluan Ding PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kelly M. McMasters MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Daniel G. Coit MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Alexander M. M. Eggermont MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Phyllis A. Gimotty PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Timothy M. Johnson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. John M. Kirkwood MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Stanley P. Leong MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Merrick I. Ross MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. David R. Byrd MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Alistair J. Cochran MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Martin C. Mihm Jr MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Donald L. Morton MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Michael B. Atkins MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Keith T. Flaherty MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Vernon K. Sondak MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Charles M. Balch MD.

Additional information

Seng-jaw Soong, Donald L. Morton: Deceased.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Balch, C.M., Thompson, J.F., Gershenwald, J.E. et al. Age as a Predictor of Sentinel Node Metastasis among Patients with Localized Melanoma: An Inverse Correlation of Melanoma Mortality and Incidence of Sentinel Node Metastasis Among Young and Old Patients . Ann Surg Oncol 21, 1075–1081 (2014). https://doi.org/10.1245/s10434-013-3464-x

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-013-3464-x

Keywords

Search

Navigation