Skip to main content

Advertisement

SpringerLink
Log in

Regional Nodal Metastatic Disease Is the Strongest Predictor of Survival in Patients with Thin Vertical Growth Phase Melanomas: A Case for SLN Staging Biopsy in These Patients

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The benefit of sentinel lymph node (SLN) biopsy for patients with thin (≤1.0 mm) melanomas, even for prognostic value, is controversial. This may partly result from the relatively small number and short follow-up of SLN-positive patients in this group. Previously, we have shown that clinical regional nodal metastatic disease (RNMD) serves as a good surrogate for SLN positivity. Here, we use RNMD as a validated surrogate for SLN positivity and examine its prognostic value in a large pre-SLN group of patients with thin vertical growth phase (VGP) lesions who would today commonly be offered SLN biopsy in our practice.

Methods

Between 1972 and 1991, 472 patients with thin VGP melanomas with at least 10 years’ follow-up were eligible for the study. Kaplan-Meier survival curves were computed for patients with and without RNMD. A multivariate Cox model and classification tree analysis were used to evaluate clinical and histopathologic predictors of survival.

Results

Sixty-seven patients (14.2%) developed recurrence, 53.7% of whom developed RNMD. Forty-five patients (9.5%) experienced melanoma-related deaths (MRD). The most statistically significant predictor of MRD was RNMD (hazard ratio [HR] 13.5, P < .0001). Thickness (HR 10.5, P = .004), axial location (HR 4.6, P = .001), and age >60 years (HR 2.7, P = .005) additionally were independently associated with an increased risk of MRD. RNMD patients demonstrated a 44.4% 10-year disease-specific mortality.

Conclusions

RNMD was the most statistically significant factor associated with MRD in patients with thin VGP lesions. This supports the prognostic use of SLN biopsy in this group, recognizing that additional factors, including thickness, axial location, and older age were independently associated with a worse survival outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

FIG. 1.
FIG. 2.

Similar content being viewed by others

References

  1. Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992; 127:392–9

    PubMed  CAS  Google Scholar 

  2. Reintgen D, Cruse CW, Wells K, et al. The orderly progression of melanoma nodal metastases. Ann Surg 1994; 220:759–67

    Article  PubMed  CAS  Google Scholar 

  3. Thompson JF, McCarthy WH, Bosch CM, et al. Sentinel lymph node status as an indicator of the presence of metastatic melanoma in regional lymph nodes. Melanoma Res 1995; 5:255–60

    PubMed  CAS  Google Scholar 

  4. Morton DL, Cochran AJ, Thompson JF, et al. Sentinel node biopsy for early-stage melanoma: accuracy and morbidity in MSLT-I, an international multicenter trial. Ann Surg 2005; 242:302–11;discussion 311–3

    PubMed  Google Scholar 

  5. Blumenthal R, Banic A, Brand CU, et al. Morbidity and outcome after sentinel lymph node dissection in patients with early-stage malignant cutaneous melanoma. Swiss Surg 2002; 8:209–14

    Article  PubMed  CAS  Google Scholar 

  6. Surveillance Epidemiology and End Results (SEER) Program. SEER 1973–2000 Public-Use Data. Available at: http://www.seer.cancer.gov/publicdata/. Accessed December 18, 2006

  7. Bleicher RJ, Essner R, Foshag LJ, et al. Role of sentinel lymphadenectomy in thin invasive cutaneous melanomas. J Clin Oncol 2003; 21:1326–31

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  9. 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 

  10. Agnese DM, Abdessalam SF, Burak WE Jr, et al. Cost-effectiveness of sentinel lymph node biopsy in thin melanomas. Surgery 2003; 134:542–7;discussion 547–8

    Article  PubMed  Google Scholar 

  11. 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; 12:449–58

    Article  PubMed  Google Scholar 

  12. Sondak VK, Taylor JM, Sabel MS, et al. Mitotic rate and younger age are predictors of sentinel lymph node positivity: lessons learned from the generation of a probabilistic model. Ann Surg Oncol 2004; 11:247–58

    Article  PubMed  Google Scholar 

  13. 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  Google Scholar 

  14. McMasters KM, Wong SL, Edwards MJ, et al. Factors that predict the presence of sentinel lymph node metastasis in patients with melanoma. Surgery 2001; 130:151–6

    Article  PubMed  CAS  Google Scholar 

  15. 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

    Article  PubMed  CAS  Google Scholar 

  16. Nguyen CL, McClay EF, Cole DJ, et al. Melanoma thickness and histology predict sentinel lymph node status. Am J Surg 2001; 181:8–11

    Article  PubMed  CAS  Google Scholar 

  17. Reintgen D, Balch CM, Kirkwood J, Ross M. Recent advances in the care of the patient with malignant melanoma. Ann Surg 1997; 225:1–14

    Article  PubMed  CAS  Google Scholar 

  18. Wong SL, Brady MS, Busam KJ, Coit DG. Results of sentinel lymph node biopsy in patients with thin melanoma. Ann Surg Oncol 2006; 13:302–9

    Article  PubMed  Google Scholar 

  19. 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; 22:3668–76

    Article  PubMed  Google Scholar 

  20. McKinnon JG, Yu XQ, McCarthy WH, Thompson JF. Prognosis for patients with thin cutaneous melanoma: long-term survival data from New South Wales Central Cancer Registry and the Sydney Melanoma Unit. Cancer 2003; 98:1223–31

    Article  PubMed  Google Scholar 

  21. Karakousis GC, Gimotty PA, Botbyl JD, et al. Predictors of regional nodal disease in patients with thin melanomas. Ann Surg Oncol 2006; 13:533–41

    Article  PubMed  Google Scholar 

  22. CP SD. CART: Tree-Structured Non-Parametric Data Analysis. San Diego: Salford Systems, 1995

    Google Scholar 

  23. Jemal A, Murray T, Ward E, et al. Cancer statistics, 2005. CA Cancer J Clin 2005; 55:10–30

    Article  PubMed  Google Scholar 

  24. Rousseau DL Jr, Ross MI, Johnson MM, et al. Revised American Joint Committee on Cancer staging criteria accurately predict sentinel lymph node positivity in clinically node-negative melanoma patients. Ann Surg Oncol 2003; 10:569–74

    Article  PubMed  Google Scholar 

  25. Stitzenberg KB, Groben PA, Stern SL, et al. Indications for lymphatic mapping and sentinel lymphadenectomy in patients with thin melanoma (Breslow thickness < or = 1.0 mm). Ann Surg Oncol 2004; 11:900–6

    Article  PubMed  Google Scholar 

  26. Olah J, Gyulai R, Korom I, et al. Tumour regression predicts higher risk of sentinel node involvement in thin cutaneous melanomas. Br J Dermatol 2003; 149:662–3

    Article  PubMed  CAS  Google Scholar 

  27. 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 

  28. Ranieri JM, Wagner JD, Wenck S, et al. The prognostic importance of sentinel lymph node biopsy in thin melanoma. Ann Surg Oncol 2006

  29. 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 

  30. Leiter U, Buettner PG, Eigentler TK, Garbe C. Prognostic factors of thin cutaneous melanoma: an analysis of the central malignant melanoma registry of the German dermatological society. J Clin Oncol 2004; 22:3660–7

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Supported in part by the SPORE on Skin Cancer (CA-093372, M. Herlyn, PI). We thank all of the patients who have been seen at the Pigmented Lesion Clinic (PLC) and who have given their consent for use of their data for research studies, and we also thank the investigators (Drs. W. H. Clark Jr. [deceased], E. E. Bondi, L. P. Bucky, L. S. Callans, B. Chang, K. T. Flaherty, A. C. Halpern, R. Hamilton, D. Hershock, D. D. Larossa, S. R. Lessin, D. Low, P. Van Belle, and J. Wolfe) and staff (R. Holmes, S. Hotz, N. Lowden, I. Matozzo, M. Price, M. Synnestvedt, and J. Thompson) of the PLC for their contributions over the last three decades to the Melanoma Core Database, on which this report is based.

Author information

Authors and Affiliations

  1. Department of Surgery, Hospital of the University of Pennsylvania, 4th Floor Silverstein Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Giorgos C. Karakousis MD, Brian J. Czerniecki MD, PhD, Douglas L. Fraker MD & Francis R. Spitz MD

  2. Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA

    Phyllis A. Gimotty PhD

  3. Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    David E. Elder MB, ChB

  4. Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Rosalie Elenitsas MD & Michael E. Ming MD, MSCE

  5. Department of Medicine, Division of Hematology and Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    DuPont Guerry MD

  6. Pigmented Lesion Group and Melanoma Program, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA, USA

    Phyllis A. Gimotty PhD, Brian J. Czerniecki MD, PhD, David E. Elder MB, ChB, Rosalie Elenitsas MD, Michael E. Ming MD, MSCE, Douglas L. Fraker MD, DuPont Guerry MD & Francis R. Spitz MD

  7. Veterans Administration Hospital, Philadelphia, PA, USA

    Francis R. Spitz MD

Authors
  1. Giorgos C. Karakousis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Phyllis A. Gimotty PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brian J. Czerniecki MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David E. Elder MB, ChB
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rosalie Elenitsas MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michael E. Ming MD, MSCE
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Douglas L. Fraker MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. DuPont Guerry MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Francis R. Spitz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francis R. Spitz MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Karakousis, G.C., Gimotty, P.A., Czerniecki, B.J. et al. Regional Nodal Metastatic Disease Is the Strongest Predictor of Survival in Patients with Thin Vertical Growth Phase Melanomas: A Case for SLN Staging Biopsy in These Patients. Ann Surg Oncol 14, 1596–1603 (2007). https://doi.org/10.1245/s10434-006-9319-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-006-9319-y

Keywords

Search

Navigation