Background: The American Joint Committee on Cancer (AJCC) has recently modified staging criteria for primary melanoma patients and recommends sentinel lymph node (SLN) biopsy in many because microscopic nodal metastasis represents the most important factor predicting survival. The purpose of this study was to correlate the incidence of SLN metastasis with revised AJCC staging.
Methods: The records of 1375 melanoma patients undergoing SLN biopsy were reviewed. Univariate and multivariate analyses were performed to identify predictors of a positive SLN. Patients were stratified by using revised AJCC criteria to determine whether such groups also predicted positive SLNs.
Results: A positive SLN was found in 16.9% of patients. By multivariate analysis, tumor thickness (relative risk [RR], 3.4) and ulceration (RR, 2.2) were dominant independent predictors of SLN metastases; age ≤50 years (RR, 1.8) and axial tumor location (RR, 1.5) were also significant. When patients were stratified by AJCC staging criteria, a significant increase in SLN metastases between successive stages was demonstrated.
Conclusions: Stratification of patients by using AJCC classification reveals an increasing risk of SLN metastases with successive stage groups. Given the significant association of SLN status and survival, the ability of the revised AJCC staging system to predict survival is likely due to its ability to predict the risk of occult nodal disease.
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
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
Balch CM, Buziad AC, Soong S-J, et al. Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. J Clin Oncol 2001; 19: 3635–48.PubMedGoogle Scholar
Balch CM, Atkins MB, Buzaid AC, et al. Melanoma of the skin. In: Greene FL, Page DL, Fleming ID, et al., eds. AJCC Cancer Staging Manual. 6th ed. New York: Springer-Verlag, 2002: 209–20.Google Scholar
Morton D, Wen D, Wong J, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992; 127: 392–9.PubMedGoogle Scholar
Ross M, Reintgen D, Balch C. Selective lymphadenectomy: emerging role for lymphatic mapping and sentinel lymph node biopsy in the management of early stage melanoma. Semin Surg Oncol 1993; 9: 219–23.PubMedGoogle Scholar
Gershenwald JE, Tseng C-H, Thompson W, et al. Improved sentinel lymph node localization in patients with primary melanoma with the use of radiolabeled colloid. Surgery 1998; 124: 203–10.PubMedGoogle Scholar
Morton DL, Thompson JF, Essner R, et al. Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma. Ann Surg 1999; 230: 453–65.CrossRefPubMedGoogle Scholar
Clary BM, Brady MS, Lewis JJ, Coit DG. Sentinel lymph node biopsy in the management of patients with primary cutaneous melanoma: review of a large single-institutional experience with an emphasis on recurrence. Ann Surg 2001; 233: 250–8.CrossRefPubMedGoogle Scholar
Dessureault S, Soong S-J, Ross MI, et al. Improved staging of node-negative patients with intermediate to thick melanomas (>1 mm) with the use of lymphatic mapping and sentinel lymph node biopsy. Ann Surg Oncol 2001; 8: 766–70.PubMedGoogle Scholar
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.PubMedGoogle Scholar
Porter GA, Ross MI, Berman RS, Lee JE, Mansfield PF, Gershenwald JE. Significance of multiple nodal basin drainage in truncal melanoma patients undergoing sentinel lymph node biopsy. Ann Surg Oncol 2000; 7: 256–61.PubMedGoogle Scholar
McMasters KM, Wong SL, Edwards MJ, et al. Factors that predict the presence of sentinel lymph node metastases in patients with melanoma. Surgery 2001; 130: 151–6.CrossRefPubMedGoogle Scholar
Gershenwald JE, Mansfield PF, Lee JE, Ross MI. Role for lymphatic mapping and sentinel lymph node biopsy in patients with thick (≥4 mm) primary melanoma. Ann Surg Oncol 2000; 7: 160–5.PubMedGoogle Scholar
Balch CM, Urist M, Karakousis C, et al. Efficacy of 2-cm surgical margins for intermediate-thickness melanomas (1 to 4 mm): results of a multi-institutional randomized surgical trial. Ann Surg 1993; 218: 262–7.PubMedGoogle Scholar
Veronisi U, Cascinelli N. Narrow excision (1-cm margin): a safe procedure for thin cutaneous melanoma. Arch Surg 1991; 126: 438–41.Google Scholar
Clark SH, Prieto VG. Processing of sentinel lymph nodes for detection of metastatic melanoma: proposal for an alternative method to serial sectioning (abstract). Lab Invest 2001; 14: 66A.Google Scholar
Balch CM, Soong S-J, Bartolucci AA, et al. Efficacy of an elective regional lymph node dissection of 1 to 4 mm thick melanomas for patients 60 years of age and younger. Ann Surg 1996; 224: 255–66.PubMedGoogle Scholar
Norman J, Wells K, Kearney R, et al. Identification of lymphatic drainage basins in patients with cutaneous melanoma. Semin Surg Oncol 1993; 9: 224–7.PubMedGoogle Scholar
Meyer C, Lechletner M, Logic J, et al. Technetium-99 sulfur-colloid cutaneous lymphoscintigraphy in the management of truncal melanoma. Radiology 1979; 131: 205–9.PubMedGoogle Scholar
Wanebo H, Harpole D, Teates D. Radionuclide lymphoscintigraphy with technetium 99m antimony sulfide colloid to identify lymphatic drainage of cutaneous melanoma at ambiguous sites in the head and neck and trunk. Cancer 1985; 55: 1403–1.PubMedGoogle Scholar
Morris KT, Stevens JS, Pommier RF, Fletcher WS, Vetto JT. Usefulness of preoperative lymphoscintigraphy for the identification of sentinel lymph nodes in melanoma. Am J Surg 2001; 181: 423–6.PubMedGoogle Scholar