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Identification of Patients with Intermediate Thickness Melanoma at Low Risk for Sentinel Lymph Node Positivity

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

Abstract

Introduction

Sentinel lymph node (SLN) biopsy is recommended for all patients with intermediate-thickness melanomas. We sought to identify such patients at low risk of SLN positivity.

Methods

All patients with intermediate-thickness melanomas (1.01–4 mm) undergoing SLN biopsy at a single institution from 1995–2011 were included in this retrospective cohort study. Univariate and multivariate logistic regression determined factors associated with a low risk of SLN positivity. Classification and regression tree (CART) analysis was used to stratify groups based on risk of positivity.

Results

Of the 952 study patients, 157 (16.5 %) had a positive SLN. In the multivariate analysis, thickness <1.5 mm (odds ratio [OR] 0.29), age ≥60 (OR 0.69), present tumor-infiltrating lymphocytes (OR 0.60), absent lymphovascular invasion (OR 0.46), and absent satellitosis (OR 0.44) were significantly associated with a low risk of SLN positivity. CART analysis identified thickness of 1.5 mm as the primary cut point for risk of SLN metastasis. Patients with a thickness of <1.5 mm represented 36 % of the total cohort and had a SLN positivity rate of 6.6 % (95 % confidence interval 3.8–9.4 %). In patients with melanomas <1.5 mm in thickness, the presence of additional low risk factors identified 257 patients (75 % of patients with <1.5 mm melanomas) in which the rate of SLN positivity was <5 %.

Conclusions

Despite a SLN positivity rate of 16.5 % overall, substantial heterogeneity of risk exists among patients with intermediate-thickness melanoma. Most patients with melanoma between 1.01 and 1.5 mm have a risk of SLN positivity similar to that in patients with thin melanomas.

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Acknowledgement

This study was supported in part by grants P50-CA093372, P30-CA016520, and P50-174523 from the National Cancer Institute. Content 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.

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    Authors and Affiliations

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

      Edmund K. Bartlett MD, Madalyn G. Peters MD, Mark S. Etherington MD, Douglas L. Fraker MD, Brian J. Czerniecki MD, PhD & Giorgos C. Karakousis MD

    2. Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, USA

      Anne Blair MS & Phyllis A. Gimotty PhD

    3. Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, USA

      David E. Elder MB, ChB & Xiaowei G. Xu MD

    4. Hematology-Oncology Division, Department of Medicine, University of Pennsylvania, Philadelphia, USA

      DuPont Guerry MD

    5. Department of Dermatology, University of Pennsylvania, Philadelphia, USA

      Michael E. Ming MD, MSCE

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    1. Edmund K. Bartlett MD
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    2. Madalyn G. Peters MD
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    Correspondence to Edmund K. Bartlett MD.

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    The authors declare no conflicts of interest.

    Additional information

    Edmund K. Bartlett and Madalyn G. Peters have contributed equally to this work.

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    Bartlett, E.K., Peters, M.G., Blair, A. et al. Identification of Patients with Intermediate Thickness Melanoma at Low Risk for Sentinel Lymph Node Positivity. Ann Surg Oncol 23, 250–256 (2016). https://doi.org/10.1245/s10434-015-4766-y

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    • DOI: https://doi.org/10.1245/s10434-015-4766-y

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