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The Prognostic Importance of Sentinel Lymph Node Biopsy in Thin Melanoma

Annals of Surgical Oncology volume 13, pages 927–932 (2006)Cite this article

Abstract

Background

Sentinel lymph node biopsy (SLNB) is prognostically useful in patients with cutaneous melanoma with Breslow thickness >1 mm. The objective of this study was to determine whether sentinel node histology has similar prognostic importance in patients with thin melanomas (≤1 mm).

Methods

This was a retrospective study of patients who underwent SLNB for clinically localized melanoma at Indiana University Medical Center between 1994 and 2003. SLNB results and traditional melanoma prognostic indicators were studied in univariate log-rank tests.

Results

One hundred eighty-four patients with melanomas ≤1 mm thick underwent SLNB. SLNB was tumor positive in 12 patients (6.5%). Univariate analysis of SLNB results revealed that Breslow thickness, Clark level of invasion, and mitotic index were associated with SLNB status. Tumor positivity was observed at different rates in tumor thickness subsets: <.75 mm, 2.3%; and .75 to 1.0 mm, 10.2% (P = .0372). Disease-free survival and overall survival were significantly associated with SLNB results in melanomas ≤1 mm (log-rank test: P < .0001 and P = .0125, respectively) at a median follow-up of 26.3 months.

Conclusions

SLNB histology in melanomas ≤1.0 mm deep is a significant predictor of outcome. SLNB should be considered for selected patients with melanomas .75 to 1.0 mm.

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References

  1. Lipsker DM, Hedelin G, Heid E, et al. Striking increase of thin melanomas contrasts with stable incidence of thick melanomas. Arch Dermatol 1999; 135:1451–6

    PubMed  CAS  Article  Google Scholar 

  2. Balch CM, Buzaid AC, Soong SJ, et al. Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. J Clin Oncol 2001; 19:3635–48

    PubMed  CAS  Google Scholar 

  3. Woods JE, Soule EH, Creagan ET. Metastasis and death in patients with thin melanomas (< 0.76 mm). Ann Surg 1983; 198:63–4

    PubMed  CAS  Google Scholar 

  4. Mansson-Brahme E, Carstensen J, Erhardt K, et al. Prognostic factors in thin cutaneous malignant melanoma. Cancer 1994; 73:2324–32

    PubMed  CAS  Google Scholar 

  5. Slingluff CL, Vollmer RT, Reintgen DS, et al. Lethal “thin” malignant melanoma: identifying patients at risk. Ann Surg 1988; 208:150–61

    PubMed  Google Scholar 

  6. Naruns PL, Nizze JA, Cochran AJ, et al. Recurrence potential of thin primary melanomas. Cancer 1986; 57:545–8

    PubMed  CAS  Google Scholar 

  7. Corsetti RL, Allen HM, Wanebo HJ. Thin ≤1 mm level III and IV melanomas are higher risk lesions for regional failure and warrant sentinel lymph node biopsy. Ann Surg Oncol 2000; 7:456–60

    PubMed  CAS  Article  Google Scholar 

  8. Guitart J, Lowe L, Piepkorn M, et al. Histological characteristics of metastasizing thin melanomas: a case-control study of 43 cases. Arch Dermatol 2002; 138:603–8

    PubMed  Article  Google Scholar 

  9. Bedrosian I, Faries MB, Guerry D, et al. Incidence of sentinel node metastases in patients with thin primary melanoma (≤1 mm) with vertical growth phase. Ann Surg Oncol 2000; 7:262–7

    PubMed  CAS  Article  Google Scholar 

  10. Oliveira Filho RS, Ferreira LM, Biasi LJ, et al. Vertical growth phase and positive sentinel node in thin melanoma. Braz J Med Biol Res 2003; 36:347–50

    PubMed  CAS  Article  Google Scholar 

  11. Wagner JD, Gordon MS, Chuang TY, et al. Predicting sentinel and residual lymph node basin disease after sentinel lymph node biopsy for melanoma. Cancer 2000; 89:453–62

    PubMed  CAS  Article  Google Scholar 

  12. 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

    PubMed  CAS  Google Scholar 

  13. Wagner JD, Ranieri J, Evdokimow DZ, et al. Patterns of initial recurrence and prognosis after sentinel lymph node biopsy and selective lymphadenectomy for melanoma. Plast Reconstr Surg 2003; 112:486–97

    PubMed  Article  Google Scholar 

  14. Lowe JB, Hurst E, Moley JF, et al. Sentinel lymph node biopsy in patients with thin melanoma. Arch Dermatol 2003; 139:617–21

    PubMed  Article  Google Scholar 

  15. Muller MG, Leeuwen PA, vanDiest PJ, et al. No indication for performing sentinel node biopsy in melanoma patients with a Breslow thickness of less than 0.9 mm. Melanoma Res 2001; 11:303–7

    Article  Google Scholar 

  16. 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

    PubMed  CAS  Google Scholar 

  17. Jacobs IA, Chang CK, DasGupta TK, et al. Role of sentinel lymph node biopsy in patients with thin (< 1 mm) primary melanoma. Ann Surg Oncol 2003; 10:558–61

    PubMed  Article  Google Scholar 

  18. Nahabedian MY, Tufaro AP, Manson PN. Sentinel lymph node biopsy for the T1 (thin) melanoma: is it necessary? Ann Plast Surg 2003; 50:601–6

    PubMed  Article  Google Scholar 

  19. Schmid-Wendtner MH, Baumert J, Schmidt M, et al. Prognostic index for cutaneous melanoma: an analysis after follow-up of 2715 patients. Melanoma Res 2001; 11:619–26

    PubMed  CAS  Article  Google Scholar 

  20. Azzola MF, Shaw HM, Thompson JF, et al. Tumor mitotic index is a more powerful prognostic indicator than ulceration in patients with primary cutaneous melanoma: an analysis of 3661 patients from a single center. Cancer 2003; 97:1488–98

    PubMed  Article  Google Scholar 

  21. Kesmodel SB, Karakousis GC, Botbyl JP, et al. Mitotic rate as a predictor for sentinel lymph node positivity in patients with thin melanomas. Ann Surg Oncol 2005; 12:449–58

    PubMed  Article  Google Scholar 

  22. Balch CM, Soong SJ, 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

    PubMed  CAS  Google Scholar 

  23. Finley JW, Gibbs JF, Rodriguez LM, et al. Pathologic and clinical features influencing outcome of thin melanoma: correlation with newly proposed staging system. Am Surg 2000; 66:527–31

    PubMed  CAS  Google Scholar 

  24. Agnese DM, Abdessalam SF, Burak WE, et al. Cost-effectiveness of sentinel lymph node biopsy in thin melanomas. Surgery 2003; 134:542–7

    PubMed  Article  Google Scholar 

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Affiliations

  1. Department of Surgery/Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indiana University–Purdue University, Indianapolis, Indiana, 46202

    Jaime M. Ranieri MD, Jeffrey D. Wagner MD, Stacie Wenck RNP & John J. Coleman III MD

  2. Department of Medicine/Biostatistics, Indiana University School of Medicine, Indiana University–Purdue University, Indianapolis, Indiana, 46202

    Cynthia S. Johnson MA

Authors
  1. Jaime M. Ranieri MD
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  2. Jeffrey D. Wagner MD
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  3. Stacie Wenck RNP
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  4. Cynthia S. Johnson MA
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  5. John J. Coleman III MD
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Correspondence to Jeffrey D. Wagner MD.

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Ranieri, J.M., Wagner, J.D., Wenck, S. et al. The Prognostic Importance of Sentinel Lymph Node Biopsy in Thin Melanoma. Ann Surg Oncol 13, 927–932 (2006). https://doi.org/10.1245/ASO.2006.04.023

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  • DOI: https://doi.org/10.1245/ASO.2006.04.023

Keywords

  • Melanoma
  • Metastases
  • Sentinel lymph node
  • Prognosis
  • Tumor thickness
  • Breslow level