Annals of Surgical Oncology

, Volume 21, Issue 3, pp 1016–1023 | Cite as

Prognosis of Patients with Melanoma and Microsatellitosis Undergoing Sentinel Lymph Node Biopsy

  • Edmund K. Bartlett
  • Meera Gupta
  • Jashodeep Datta
  • Phyllis A. Gimotty
  • DuPont Guerry
  • Xiaowei Xu
  • David E. Elder
  • Brian J. Czerniecki
  • Douglas L. Fraker
  • Giorgos C. Karakousis



Melanoma microsatellitosis is classified as stage IIIB/C disease and is associated with a poor prognosis. Prognostic factors within this group, however, have not been well characterized.


We performed a retrospective analysis of 1,621 patients undergoing sentinel lymph node (SLN) biopsy at our institution (1996–2011) to compare patients with (n = 98) and patients without (n = 1,523) microsatellites. Univariate and multivariate logistic and Cox regression analyses were used to identify factors associated with SLN positivity and melanoma-specific survival (MSS) in patients with microsatellites.


Patients with microsatellites were older and had lesions with higher Clark level and greater thickness that more frequently had mitoses, ulceration, and lymphovascular invasion (LVI) (all p < 0.0001). In microsatellite patients, the SLN positivity rate was 43 %. Lesional ulceration (odds ratio [OR] = 2.9, 95 % confidence interval [CI] 1.5–8.6), absent tumor infiltrating lymphocytes (OR = 2.8, 95 % CI 1.1–7.1), and LVI (OR = 3.3, 95 % CI 1.7–10) were significantly associated with SLN positivity by multivariate analysis. With a median follow-up of 4.5 years in survivors, ulceration (hazards ratio [HR] = 3.4, 95 % CI 1.5–7.8) and >1 metastatic LN (HR = 2.7, 95 % CI 1.1–6.6) were significantly associated with decreased MSS by multivariate analysis. In patients without these prognostic factors, the 5-year MSS was 90 % (n = 49) compared with 50 % (n = 23) among patients with ulceration only, 51 % (n = 12) in those with >1 metastatic LN only, or 25 % in those with both (n = 14, p < 0.01).


Microsatellitosis was frequently associated with multiple adverse pathologic features. In the absence of ulceration and >1 metastatic LN; however, the outcome for patients with microsatellites compared favorably to stage IIIB patients overall.


  1. 1.
    Balch CM, Gershenwald JE, Soong SJ, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27(36):6199–206.PubMedCrossRefGoogle Scholar
  2. 2.
    Balch CM, Gershenwald JE, Soong SJ, et al. Multivariate analysis of prognostic factors among 2,313 patients with stage III melanoma: comparison of nodal micrometastases versus macrometastases. J Clin Oncol. 2010;28(14):2452–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Morton DL, Thompson JF, Cochran AJ, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355(13):1307–17.PubMedCrossRefGoogle Scholar
  4. 4.
    Hayes AJ, Clark MA, Harries M, Thomas JM. Management of in-transit metastases from cutaneous malignant melanoma. Br J Surg. 2004;91(6):673–82.PubMedCrossRefGoogle Scholar
  5. 5.
    Murali R, Moncrieff MD, Hong J, et al. The prognostic value of tumor mitotic rate and other clinicopathologic factors in patients with locoregional recurrences of melanoma. Ann Surg Oncol. 2010;17(11):2992–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Wong JH, Cagle LA, Kopald KH, et al. Natural history and selective management of in transit melanoma. J Surg Oncol. 1990;44(3):146–50.PubMedCrossRefGoogle Scholar
  7. 7.
    Edge SB, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual. 7th edn. Vol. XV, 2010.Google Scholar
  8. 8.
    Day CL Jr, Harrist TJ, Gorstein F, et al. Malignant melanoma. Prognostic significance of “microscopic satellites” in the reticular dermis and subcutaneous fat. Ann Surg. 1981;194(1):108–12.PubMedCrossRefGoogle Scholar
  9. 9.
    Leon P, Daly JM, Synnestvedt M, et al. The prognostic implications of microscopic satellites in patients with clinical stage I melanoma. Arch Surg. 1991;126(12):1461–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Nagore E, Oliver V, Botella-Estrada R, et al. Prognostic factors in localized invasive cutaneous melanoma: high value of mitotic rate, vascular invasion and microscopic satellitosis. Melanoma Res. 2005;15(3):169–77.PubMedCrossRefGoogle Scholar
  11. 11.
    Rao UN, Ibrahim J, Flaherty LE, et al. Implications of microscopic satellites of the primary and extracapsular lymph node spread in patients with high-risk melanoma: pathologic corollary of Eastern Cooperative Oncology Group Trial E1690. J Clin Oncol. 2002;20(8):2053–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Shaikh L, Sagebiel RW, Ferreira CM, et al. The role of microsatellites as a prognostic factor in primary malignant melanoma. Arch Dermatol. 2005;141(6):739–42.PubMedCrossRefGoogle Scholar
  13. 13.
    Azimi F, Scolyer RA, Rumcheva P, et al. Tumor-infiltrating lymphocyte grade is an independent predictor of sentinel lymph node status and survival in patients with cutaneous melanoma. J Clin Oncol. 2012;30(21):2678–83.PubMedCrossRefGoogle Scholar
  14. 14.
    Buzaid AC, Ross MI, Balch CM, et al. Critical analysis of the current American Joint Committee on Cancer staging system for cutaneous melanoma and proposal of a new staging system. J Clin Oncol. 1997;15(3):1039–51.PubMedGoogle Scholar
  15. 15.
    Kimsey TF, Cohen T, Patel A, et al. Microscopic satellitosis in patients with primary cutaneous melanoma: implications for nodal basin staging. Ann Surg Oncol. 2009;16(5):1176–83.PubMedCrossRefGoogle Scholar
  16. 16.
    Harrist TJ, Rigel DS, Day CL, Jr., et al. “Microscopic satellites” are more highly associated with regional lymph node metastases than is primary melanoma thickness. Cancer. 1984;53(10):2183–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Gimotty PA, Guerry D, Ming ME, et al. Thin primary cutaneous malignant melanoma: a prognostic tree for 10-year metastasis is more accurate than American Joint Committee on Cancer staging. J Clin Oncol. 2004;22(18):3668–76.PubMedCrossRefGoogle Scholar
  18. 18.
    Kesmodel SB, Karakousis GC, Botbyl JD, et al. Mitotic rate as a predictor of sentinel lymph node positivity in patients with thin melanomas. Ann Surg Oncol. 2005;12(6):449–58.PubMedCrossRefGoogle Scholar
  19. 19.
    Gordis L. Epidemiology. Saunders, Elsevier 2009.Google Scholar
  20. 20.
    Rosner B. Fundamentals of biostatistics, 7th edn. Brooks/Cole Cengage Learning, 2011.Google Scholar
  21. 21.
    Harrell FE. Regression modeling strategies: with applications to linear models, logistic regression, and survival analysis. New York: Springer, 2001.CrossRefGoogle Scholar
  22. 22.
    Juul SF. An introduction to Stata for health researchers. 3rd edn. StataCorp LP 2010; pp 179–96.Google Scholar
  23. 23.
    Balch CM. Microscopic satellites around a primary melanoma: another piece of the puzzle in melanoma staging. Ann Surg Oncol. 2009;16(5):1092–4.PubMedCrossRefGoogle Scholar
  24. 24.
    Balch CM, Soong S, Ross MI, et al. Long-term results of a multi-institutional randomized trial comparing prognostic factors and surgical results for intermediate thickness melanomas (1.0 to 4.0 mm). Intergroup Melanoma Surgical Trial. Ann Surg Oncol. 2000;7(2):87–97.PubMedCrossRefGoogle Scholar
  25. 25.
    Borgstein PJ, Meijer S, van Diest PJ. Are locoregional cutaneous metastases in melanoma predictable? Ann Surg Oncol. 1999;6(3):315–21.PubMedCrossRefGoogle Scholar
  26. 26.
    Cascinelli N, Bufalino R, Marolda R, et al. Regional non-nodal metastases of cutaneous melanoma. Eur J Surg Oncol. 1986;12(2):175–80.PubMedGoogle Scholar
  27. 27.
    Pawlik TM, Ross MI, Thompson JF, et al. The risk of in-transit melanoma metastasis depends on tumor biology and not the surgical approach to regional lymph nodes. J Clin Oncol. 2005;23(21):4588–90.PubMedCrossRefGoogle Scholar
  28. 28.
    Weide B, Faller C, Buttner P, et al. Prognostic factors of melanoma patients with satellite or in-transit metastasis at the time of stage III diagnosis. PLoS One. 2013;8(4):e63137.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Edmund K. Bartlett
    • 1
  • Meera Gupta
    • 1
  • Jashodeep Datta
    • 1
  • Phyllis A. Gimotty
    • 2
  • DuPont Guerry
    • 3
  • Xiaowei Xu
    • 4
  • David E. Elder
    • 4
  • Brian J. Czerniecki
    • 1
  • Douglas L. Fraker
    • 1
  • Giorgos C. Karakousis
    • 1
  1. 1.Department of SurgeryUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Department of Biostatistics and EpidemiologyUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Hematology-Oncology Division, Department of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.Department of PathologyUniversity of PennsylvaniaPhiladelphiaUSA

Personalised recommendations