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Thin Melanoma with Nodal Involvement: Analysis of Demographic, Pathologic, and Treatment Factors with Regard to Prognosis

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

Abstract

Background

Although only a small proportion of thin melanomas result in lymph node metastasis, the abundance of these lesions results in a relatively large absolute number of patients with a diagnosis of nodal metastases, determined by either sentinel lymph node (SLN) biopsy or clinical nodal recurrence (CNR).

Methods

Independent cohorts with thin melanoma and either SLN metastasis or CNR were identified at two melanoma referral centers. At both centers, SLN metastasis patients were included. At center 1, the CNR cohort included patients with initial negative clinical nodal evaluation followed by CNR. At center 2, the CNR cohort was restricted to those presenting in the era before the use of SLN biopsy. Uni- and multivariable analyses of melanoma-specific survival (MSS) were performed.

Results

At center 1, 427 CNR patients were compared with 91 SLN+ patients. The 5- and 10-year survival rates in the SLN group were respectively 88 and 84 % compared with 72 and 49 % in the CNR group (p < 0.0001). The multivariate analysis showed age older than 50 years (hazard ratio [HR] 1.5; 95 % confidence interval [CI] 1.2–1.9), present ulceration (HR 1.9; 95 % CI 1.2–2.9), unknown ulceration (HR 1.6; 95 % CI 1.3–2.1), truncal site (HR 1.6; 95 % CI 1.2–2.2), and CNR (HR 3.3; 95 % CI 1.8–6.0) to be associated significantly with decreased MSS (p < 0.01 for each). The center 2 cohort demonstrated remarkably similar findings, with a 5-year MSS of 88 % in the SLN (n = 29) group and 76 % in the CNR group (n = 39, p = 0.09).

Conclusion

Patients with nodal metastases from thin melanomas have a substantial risk of melanoma death. This risk is lower among patients whose disease is discovered by SLN biopsy rather than CNR.

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Acknowledgment

This study was supported by Grants P50-CA093372, P30-CA016520, P01-CA29605, and R01 CA189163 from the National Cancer Institute, the Dr. Miriam & Sheldon G. Adelson Medical Research Foundation (Boston, MA, USA), the Borstein Family Foundation, (Los Angeles, CA, USA), and the John Wayne Cancer Institute Auxiliary (Santa Monica, CA, USA). The content of this report is solely the responsibility of the authors and does not necessarily represent the official view of the National Cancer Institute or the National Institutes of Health.

Conflicts of interest

The authors have no conflicts of interest to disclose regarding the contents of this study or its publication.

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Authors and Affiliations

  1. Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Giorgos Karakousis MD, Phyllis A. Gimotty PhD, Edmund K. Bartlett MD, Madalyn G. Neuwirth MD & Douglas Fraker MD

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

    Myung-Shin Sim PhD & Mark B. Faries MD

  3. Moffit Cancer Center, Tampa, FL, USA

    Brian J. Czerniecki MD, PhD

Authors
  1. Giorgos Karakousis MD
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  2. Phyllis A. Gimotty PhD
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  3. Edmund K. Bartlett MD
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  4. Myung-Shin Sim PhD
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  5. Madalyn G. Neuwirth MD
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  6. Douglas Fraker MD
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  7. Brian J. Czerniecki MD, PhD
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  8. Mark B. Faries MD
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Corresponding author

Correspondence to Giorgos Karakousis MD.

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Karakousis, G., Gimotty, P.A., Bartlett, E.K. et al. Thin Melanoma with Nodal Involvement: Analysis of Demographic, Pathologic, and Treatment Factors with Regard to Prognosis. Ann Surg Oncol 24, 952–959 (2017). https://doi.org/10.1245/s10434-016-5646-9

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  • DOI: https://doi.org/10.1245/s10434-016-5646-9

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