Annals of Surgical Oncology

, 16:2978

Prognostic Significance of a Positive Nonsentinel Lymph Node in Cutaneous Melanoma

  • Amir A. Ghaferi
  • Sandra L. Wong
  • Timothy M. Johnson
  • Lori Lowe
  • Alfred E. Chang
  • Vincent M. Cimmino
  • Carol R. Bradford
  • Riley S. Rees
  • Michael S. Sabel
Melanomas

DOI: 10.1245/s10434-009-0665-4

Cite this article as:
Ghaferi, A.A., Wong, S.L., Johnson, T.M. et al. Ann Surg Oncol (2009) 16: 2978. doi:10.1245/s10434-009-0665-4

Abstract

Purpose

Sentinel lymph node (SLN) biopsy provides important prognostic information for patients with cutaneous melanoma. There may be additional prognostic significance to melanoma spreading from the SLN to nonsentinel lymph nodes (NSLN). We examined the implications of a positive NSLN for overall and distant disease-free survival.

Methods

Using a prospectively maintained, Institutional Review Board-approved melanoma database we studied patients who had a cutaneous melanoma, a positive SLN, and a completion lymph node dissection (CLND). Survival was determined using a combination of hospital records and the Social Security Death Index (SSDI). Univariate and multivariate Cox regression analysis was performed to further characterize predictors of overall and distant disease-free survival. Kaplan–Meier analysis was used to generate survival curves.

Results

A total of 429 patients with positive SLN biopsies were identified, with at least one positive NSLN identified in 71 (17%). Median follow-up time was 36.8 months. Presence of a positive NSLN was significantly associated with poor outcome, although long-term survival was possible. Presence of ulceration, high mitotic rate, angiolymphatic invasion, total number of positive nodes, and volume of disease >1% in the SLN were significant predictors of survival on univariate analysis, but lost significance on multivariate. Multivariate Cox analysis revealed several predictors of overall survival: increasing age [hazard ratio (HR) 1.04, P < 0.01], Breslow depth (HR 1.76, P < 0.01), presence of extracapsular extension in the SLN (HR 2.39, P < 0.01), and positive NSLN (HR 1.92, P < 0.01).

Conclusion

Among node-positive melanoma patients, presence of a positive NSLN is a highly significant poor prognostic sign, even after considering the total number of positive nodes and volume of disease in the SLN. CLND after a positive SLN provides this important prognostic information.

Copyright information

© Society of Surgical Oncology 2009

Authors and Affiliations

  • Amir A. Ghaferi
    • 1
  • Sandra L. Wong
    • 1
  • Timothy M. Johnson
    • 1
    • 2
  • Lori Lowe
    • 2
    • 3
  • Alfred E. Chang
    • 1
  • Vincent M. Cimmino
    • 1
  • Carol R. Bradford
    • 4
  • Riley S. Rees
    • 1
  • Michael S. Sabel
    • 1
  1. 1.Department of SurgeryUniversity of Michigan Health SystemAnn ArborUSA
  2. 2.Department of DermatologyUniversity of Michigan Health SystemAnn ArborUSA
  3. 3.Department of PathologyUniversity of Michigan Health SystemAnn ArborUSA
  4. 4.Department of OtolaryngologyUniversity of Michigan Health SystemAnn ArborUSA