Annals of Surgical Oncology

, Volume 24, Issue 4, pp 952–959

Thin Melanoma with Nodal Involvement: Analysis of Demographic, Pathologic, and Treatment Factors with Regard to Prognosis

  • Giorgos Karakousis
  • Phyllis A. Gimotty
  • Edmund K. Bartlett
  • Myung-Shin Sim
  • Madalyn G. Neuwirth
  • Douglas Fraker
  • Brian J. Czerniecki
  • Mark B. Faries
Melanomas

DOI: 10.1245/s10434-016-5646-9

Cite this article as:
Karakousis, G., Gimotty, P.A., Bartlett, E.K. et al. Ann Surg Oncol (2017) 24: 952. doi:10.1245/s10434-016-5646-9
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Abstract

Background

Although only a small proportion of thin melanomas result in lymph node metastasis, the abundance of these lesions results in a relatively large absolute number of patients with a diagnosis of nodal metastases, determined by either sentinel lymph node (SLN) biopsy or clinical nodal recurrence (CNR).

Methods

Independent cohorts with thin melanoma and either SLN metastasis or CNR were identified at two melanoma referral centers. At both centers, SLN metastasis patients were included. At center 1, the CNR cohort included patients with initial negative clinical nodal evaluation followed by CNR. At center 2, the CNR cohort was restricted to those presenting in the era before the use of SLN biopsy. Uni- and multivariable analyses of melanoma-specific survival (MSS) were performed.

Results

At center 1, 427 CNR patients were compared with 91 SLN+ patients. The 5- and 10-year survival rates in the SLN group were respectively 88 and 84 % compared with 72 and 49 % in the CNR group (p < 0.0001). The multivariate analysis showed age older than 50 years (hazard ratio [HR] 1.5; 95 % confidence interval [CI] 1.2–1.9), present ulceration (HR 1.9; 95 % CI 1.2–2.9), unknown ulceration (HR 1.6; 95 % CI 1.3–2.1), truncal site (HR 1.6; 95 % CI 1.2–2.2), and CNR (HR 3.3; 95 % CI 1.8–6.0) to be associated significantly with decreased MSS (p < 0.01 for each). The center 2 cohort demonstrated remarkably similar findings, with a 5-year MSS of 88 % in the SLN (n = 29) group and 76 % in the CNR group (n = 39, p = 0.09).

Conclusion

Patients with nodal metastases from thin melanomas have a substantial risk of melanoma death. This risk is lower among patients whose disease is discovered by SLN biopsy rather than CNR.

Funding information

Funder NameGrant NumberFunding Note
National Cancer Institute
  • P01-CA29605
  • R01 CA189163
  • P50-CA093372
  • P30-CA016520

Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Giorgos Karakousis
    • 1
  • Phyllis A. Gimotty
    • 1
  • Edmund K. Bartlett
    • 1
  • Myung-Shin Sim
    • 2
  • Madalyn G. Neuwirth
    • 1
  • Douglas Fraker
    • 1
  • Brian J. Czerniecki
    • 3
  • Mark B. Faries
    • 2
  1. 1.Department of SurgeryHospital of the University of PennsylvaniaPhiladelphiaUSA
  2. 2.John Wayne Cancer InstituteSanta MonicaUSA
  3. 3.Moffit Cancer CenterTampaUSA

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