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Sentinel Node Biopsy Improves Prognostic Stratification in Patients with Thin (pT1) Melanomas and an Additional Risk Factor

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

Abstract

Background

Sentinel lymph node (SLN) biopsy (SLNB) for pT1 melanomas is not generally recognized as a clinical standard. We studied the value of SLNB for pT1 melanoma patients having at least one additional risk factor.

Patients

Among 931 patients with SLNB, 210 had pT1 melanomas. All of the latter showed at least one of the following risk factors: ulceration (4 %) Clark level IV (44 %), nodular growth pattern (11 %), mitoses (59 %), regression (38 %) or age ≤40 years (27 %).

Results

In this selected pT1 population, we observed a surprisingly high SLN positivity rate of 18 %. The melanoma-specific overall survival significantly depended on SLN status. Compared with Clark IV, a lower invasion level (Clark II/III) was associated with a higher proportion of positive SLNs (25 vs. 10 %; p < 0.01). There was a trend towards a higher SLN positivity rate in younger patients (p = 0.06). Breslow, ulceration, mitoses, nodular growth pattern, and sex did not reach significance. Regression was significantly more frequently found in very thin melanomas (≤0.75 mm) and tended to be significant in this subgroup (p = 0.075).

Conclusions

SLNB improves prognostic stratification in patients with thin melanomas having an additional risk factor. Clark level IV most likely does not belong to these risk factors. The impact of regression deserves further consideration. Our data suggest that SLNB should be offered to patients with thin melanomas, if ulceration, nodular growth pattern, mitoses, or regression are present, or if the patient is younger than 40 years of age.

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Authors and Affiliations

  1. Department of Dermatology, Venereology and Allergology, Klinikum Hildesheim GmbH, Hildesheim, Germany

    Christina Mitteldorf MD & Michael Tronnier MD

  2. Department of Dermatology, Venereology and Allergology, Georg August University of Göttingen, Göttingen, Germany

    Hans Peter Bertsch MD, Kai-Martin Thoms MD, Michael Peter Schön MD & Lutz Kretschmer MD

  3. Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany

    Klaus Jung PhD

Authors
  1. Christina Mitteldorf MD
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  2. Hans Peter Bertsch MD
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  3. Klaus Jung PhD
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  4. Kai-Martin Thoms MD
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  5. Michael Peter Schön MD
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  6. Michael Tronnier MD
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  7. Lutz Kretschmer MD
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Corresponding author

Correspondence to Christina Mitteldorf MD.

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Mitteldorf, C., Bertsch, H.P., Jung, K. et al. Sentinel Node Biopsy Improves Prognostic Stratification in Patients with Thin (pT1) Melanomas and an Additional Risk Factor. Ann Surg Oncol 21, 2252–2258 (2014). https://doi.org/10.1245/s10434-014-3641-6

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  • DOI: https://doi.org/10.1245/s10434-014-3641-6

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