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Annals of Surgical Oncology

, Volume 7, Issue 4, pp 262–267 | Cite as

Incidence of Sentinel Node Metastasis in Patients With Thin Primary Melanoma (#1 mm) With Vertical Growth Phase

  • Isabelle Bedrosian
  • Mark B. Faries
  • DuPont Guerry IV
  • Rosalie Elenitsas
  • Lynn Schuchter
  • Rosemarie Mick
  • Francis R. Spitz
  • Louis P. Bucky
  • Abass Alavi
  • David E. Elder
  • Douglas L. Fraker
  • Brian J. Czerniecki
Original Articles

Abstract

Background: Patients with thin primary melanomas (#1 mm) generally have an excellent prognosis. However, the presence of a vertical growth phase (VGP) adversely impacts the survival rate. We report on the rate of occurrence of nodal metastasis in patients with thin primary melanomas with a VGP who are offered sentinel lymph node (SLN) biopsy.

Methods: Among 235 patients with clinically localized cutaneous melanomas who underwent successful SLN biopsy, 71 had lesions 1 mm or smaller with a VGP. The SLN was localized by using blue dye and a radiotracer. If negative for tumor by using hematoxylin and eosin staining, the SLN was further examined by immunohistochemistry.

Results: The rate of occurrence of SLN metastasis was 15.2% in patients with melanomas deeper than 1 mm and 5.6% in patients with thin melanomas. Three patients with thin melanomas and a positive SLN had low-risk lesions, based on a highly accurate six-variable multivariate logistic regression model for predicting 8-year survival in stage I/II melanomas. The fourth patient had a low- to intermediate-risk lesion based on this model. At the time of the lymphadenectomy, one patient had two additional nodes with metastasis.

Conclusions: VGP in a melanoma 1 mm or smaller seems to be a risk factor for nodal metastasis. The risk of nodal disease may not be accurately predicted by the use of a multivariate logistic regression model that incorporates thickness, mitotic rate, regression, tumor-infiltrating lymphocytes, sex, and anatomical site. Patients with thin lesions having VGP should be evaluated for SLN biopsy and trials of adjuvant therapy when stage III disease is found.

Key Words:

Vertical growth phase—Thin melanoma—Sentinel node—Metastasis. 

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REFERENCES

  1. 1.
    Slingluff CL, Seigler H. Melanoma. In: Sabiston DCJ, ed.Textbook of Surgery: The Basis of Modern Surgical Practice. 15th ed. Philadelphia: W.B. Saunders, 1997:515–28.Google Scholar
  2. 2.
    Rigel D, Friedman R, Kopf A. The incidence of malignant melanoma in the United States: issues as we approach the 21st century. J Am Acad Dermatol 1996;34:839–47.PubMedGoogle Scholar
  3. 3.
    Consensus Statement. Diagnosis and treatment of early melanoma. NIH Consensus Development Conference January 27–29, 1992.Google Scholar
  4. 4.
    Kelly JW, Sagebiel RW, Clyman S, Blois MS.Thin level IV malignant melanoma: a subset in which level is the major prognostic indicator. Ann Surg 1985;202:98–103.PubMedGoogle Scholar
  5. 5.
    Naruns PL, Nizze JA, Cochran AJ, Lee MB, Morton DL. Recurrence potential of thin primary melanomas. Cancer 1986;57:545–8.PubMedGoogle Scholar
  6. 6.
    Shaw HM, McCarthy WH, McCarthy SW, Milton GW.Thin malignant melanomas and recurrence potential. Arch Surg 1987; 122:1147–50.PubMedGoogle Scholar
  7. 7.
    Slingluff CLJr, Vollmer RT, Reintgen DS, Seigler HF. Lethal. “thin” malignant melanoma. Ann Surg 1988;208:150–61.PubMedGoogle Scholar
  8. 8.
    Woods JE, Soule EH, Creagan ET.Metastasis and death in patients with thin melanoma (less than 0.76 mm). Ann Surg 1983;198: 63–4.PubMedGoogle Scholar
  9. 9.
    Clark W Jr, Elder D, Guerry IV D, et al. Model predicting survival in stage I melanoma based on tumor progression. J Natl Cancer Inst 1989;81:1893–1904.PubMedGoogle Scholar
  10. 10.
    Szymik B, Woosley J. Further validation of the prognostic model for stage I malignant melanoma based on tumor progression. J Cutan Pathol 1993;20:50 –3.PubMedGoogle Scholar
  11. 11.
    Clark WH Jr, Elder DE, Guerry D IV, Epstein MN, Greene MH, Van Horn M. A study of tumor progression: the precursor lesions of superficial spreading and nodular melanoma. Hum Pathol 1984; 15:1147–65.CrossRefPubMedGoogle Scholar
  12. 12.
    Herlyn M, Clark WH, Rodeck U, Mancianti ML, Jambrosic J, Koprowski H. Biology of tumor progression in human melanocytes. Lab Invest 1987;56:461–74.PubMedGoogle Scholar
  13. 13.
    Guerry D IV, Synnestvedt M, Elder D, Schultz D. Lessons from tumor progression: the invasive radial growth phase of melanoma is common, incapable of metastasis, and indolent. J Invest Dermatol 1993;100:342S–5S.PubMedGoogle Scholar
  14. 14.
    Straume O, Akslen L. Independent prognostic importance of vascular invasion in nodular melanomas. Cancer 1996;78:1211–9.PubMedGoogle Scholar
  15. 15.
    Johnson OJ, Emrich L, Karakousis C, Rao U, Greco W. Comparison of prognostic factors for survival and recurrence in malignant melanoma of the skin, clinical stage I. Cancer 1985;55:1107–17.PubMedGoogle Scholar
  16. 16.
    Herlyn M, Balaban G, Bennicelli J, et al. Primary melanoma cells of the vertical growth phase: similarities to metastatic cells. J Natl Cancer Inst 1985;74:283–9.PubMedGoogle Scholar
  17. 17.
    Elder D, Rodeck U, Thurin J, et al. Antigenic profile of tumor progression stages in human melanocytic nevi and melanoma. Cancer Res 1989;49:5091–6.PubMedGoogle Scholar
  18. 18.
    Rak J, Hegmann E, Lu C, Kerbel R. Progressive loss of sensitivity to endothelium derived growth inhibitors expressed by human melanoma cells during disease progression. J Cell Physiol 1994; 159:245–55.PubMedGoogle Scholar
  19. 19.
    Wanebo HJ, Cooper PH, Hagar RW. Thin (,1 mm) melanomas of the extremities are biologically favorable lesions not influenced by regression. Ann Surg 1985;201:499 –504.PubMedCrossRefGoogle Scholar
  20. 20.
    Gromet M, Epstein W, Blois M. The regressing thin malignant melanoma: a distinctive lesion with metastatic potential. Cancer 1978;42:2282–92.PubMedGoogle Scholar
  21. 21.
    Paladugu R, Yonemoto R. Biologic behavior of thin malignant melanoma with regressive changes. Arch Surg 1983;118:41–4.PubMedGoogle Scholar
  22. 22.
    Ronan SG, Eng AM, Briele HA, Shioura NN, Das Gupta TK. Thin malignant melanomas with regression and metastases. Arch Dermatol 1987;123:1326–30.PubMedGoogle Scholar
  23. 23.
    McCarthy W, Shaw H, McCarthy S, Rivers J, Thompson J. Cutaneous melanomas that defy conventional prognostic indicators. Semin Oncol 1996;23:709 –13.PubMedGoogle Scholar
  24. 24.
    Krag D, Meijer S, Weaver D, et al. Minimal access surgery for staging of malignant melanoma. Arch Surg 1995;130:654–8.PubMedGoogle Scholar
  25. 25.
    McDermott N, Hayes D, al-Sader M, et al. Identification of vertical growth phase in malignant melanoma: a study of interobserver agreement. Am J Clin Pathol 1998;110:753–7.PubMedGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 2000

Authors and Affiliations

  • Isabelle Bedrosian
    • 2
  • Mark B. Faries
    • 2
  • DuPont Guerry IV
    • 5
  • Rosalie Elenitsas
    • 5
  • Lynn Schuchter
    • 5
  • Rosemarie Mick
    • 3
  • Francis R. Spitz
    • 2
  • Louis P. Bucky
    • 2
  • Abass Alavi
    • 4
  • David E. Elder
    • 5
  • Douglas L. Fraker
    • 2
  • Brian J. Czerniecki
    • 5
    • 1
  1. 1.Department of DermatologyUniversity of PennsylvaniaPhiladelphia
  2. 2.Department of SurgeryUniversity of PennsylvaniaPhiladelphia
  3. 3.Department of Biostatistics and EpidemiologyUniversity of PennsylvaniaPhiladelphia
  4. 4.Department of RadiologyUniversity of PennsylvaniaPhiladelphia
  5. 5.Cancer Center and the Pigmented Lesion GroupUniversity of PennsylvaniaPhiladelphia

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