Annals of Surgical Oncology

, Volume 9, Issue 10, pp 975–981 | Cite as

Prognostic importance of lymph node tumor burden in melanoma patients staged by sentinel node biopsy

  • Jaime M. Ranieri
  • Jeffrey D. Wagner
  • Rafael Azuaje
  • D. Davidson
  • Stacie Wenck
  • Joanne Fyffe
  • John J. ColemanIII
Original Articles



The objective of this study was to investigate the relationship between nodal tumor burden and the outcomes of recurrence and survival in sentinel node-positive melanoma patients.


We reviewed a series of sentinel node-positive patients with primary cutaneous melanoma treated with completion lymph node dissection (CLND). Microscopic nodal tumor deposits were counted and measured with an ocular micrometer. Various measures of tumor burden and traditional melanoma prognostic indicators were studied in multivariate Cox regression models.


Sentine lympho node and CLND specimens were evaluated in 90 node-positive patients. The diameter of the largest lymph node tumor nodule and the total lymph node tumor volume were significant predictors of recurrence (two-sideP<.0001 for both) and survival (two-sidedP=.0018 andP=.0002, respectively). A tumor deposit diameter of 3 mm was identified as the most significant cut point predictive of recurrence (P<.0001; hazard ratio, 5.18) and survival (P<.0001; hazard ratio, 5.43). The 3-year survival probability was .86 for patients with largest tumor deposit diameters of ≤3 mm and was .27 for patients with largest deposit diameters >3 mm (P<.0001).


Microstaging of melanoma sentinel lymph node/CLND specimens by using the diameter of the largest tumor deposit is a highly significant predictor of early relapse and survival.

Key Words

Melanoma Metastasis Nodal tumor burden Lymph nodes 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Balch CM, Buzaid AC, Soong S-J, et al. Final version of the American Joint Commitee on Cancer staging system for cutaneous melaroma.J Clin Oncol 2001;19:3635–48.PubMedGoogle Scholar
  2. 2.
    Morton DL, Wen DR, Wong JH, et al. Technical details of intra-operative lymphatic mapping for early stage melanoma.Arch Surg 1992;127:392–9.PubMedGoogle Scholar
  3. 3.
    Balch CM, Soong S-J, 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.PubMedGoogle Scholar
  4. 4.
    Gershenwald JE, Thompson W, Mansfield PF, et al. Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients.J Clin Oncol 1999;17:976–83.PubMedGoogle Scholar
  5. 5.
    Yu LL, Flotte TJ, Tanabe KK, et al. Detection of microscopic melanoma metastases in sentinel lymph nodes.Cancer 1999;86: 617–27.PubMedCrossRefGoogle Scholar
  6. 6.
    Wagner JD, Davidson D, Coleman JJ III, et al. Lymph node tumor volumes in patients undergoing sentinel lymph node biopsy for cutaneous melanoma.Ann Surg Oncol 1999;6:398–404.PubMedCrossRefGoogle Scholar
  7. 7.
    Wagner JD, Gordon MS, Chuang T-Y, et al. Predicting sentinel and residual lymph node basin disease after sentinel lymph node biopsy for melanoma.Cancer 2000;89:453–62.PubMedCrossRefGoogle Scholar
  8. 8.
    Bevilacqua RG, Coit DG, Rogatko A, Younes RN, Brennan MF. Axillary dissection in melanoma: prognostic variables in node-positive patients.Ann Surg 1990;212:125–31.PubMedCrossRefGoogle Scholar
  9. 9.
    Coit DG, Rogatko A, Brennan MF. Prognostic factors in patients with melanoma metastatic to axillary or inguinal lymph nodes. A multivariate analysis.Ann Surg 1991;214:627–36.PubMedCrossRefGoogle Scholar
  10. 10.
    Drepper H, Biess B, Hofherr B, et al. The prognosis of patients with stage III melanoma. Prospective long-term study of 286 patients of the Fachklinik Hornheide.Cancer 1993;71:1239–46.PubMedCrossRefGoogle Scholar
  11. 11.
    Buzaid AC, Tinoco LA, Jendiroba D, et al. Prognostic value of size of lymph node metastases in patients with cutaneous melanoma.J Clin Oncol 1995;13:2361–8.PubMedGoogle Scholar
  12. 12.
    Joseph E, Brobeil A, Glass F, et al. Results of complete lymph node dissection in 83 patients with positive sentinel nodes.Ann Surg Oncol 1998;5:119–25.PubMedCrossRefGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc 2002

Authors and Affiliations

  • Jaime M. Ranieri
    • 1
  • Jeffrey D. Wagner
    • 1
  • Rafael Azuaje
    • 1
  • D. Davidson
    • 2
  • Stacie Wenck
    • 1
  • Joanne Fyffe
    • 3
  • John J. ColemanIII
    • 1
  1. 1.Department of Surgery/Plastic and Reconstructive SurgeryIndiana University School of Medicine, Indiana University-Purdue UniversityIndianapolis
  2. 2.Department of PathologyIndiana University School of Medicine, Indiana University-Purdue UniversityIndianapolis
  3. 3.Department of Medicine/ BiostatisticsIndiana University School of Medicine, Indiana University-Purdue UniversityIndianapolis

Personalised recommendations