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Predictors of Sentinel Lymph Node Metastasis in Patients with Thin Melanoma: An International Multi-institutional Collaboration

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

Abstract

Background

Consideration of sentinel lymph node biopsy (SLNB) is recommended for patients with T1b melanomas and T1a melanomas with high-risk features; however, the proportion of patients with actionable results is low. We aimed to identify factors predicting SLNB positivity in T1 melanomas by examining a multi-institutional international population.

Methods

Data were extracted on patients with T1 cutaneous melanoma who underwent SLNB between 2005 and 2018 at five tertiary centers in Europe and Canada. Univariable and multivariable logistic regression analyses were performed to identify predictors of SLNB positivity.

Results

Overall, 676 patients were analyzed. Most patients had one or more high-risk features: Breslow thickness 0.8–1 mm in 78.1% of patients, ulceration in 8.3%, mitotic rate > 1/mm2 in 42.5%, Clark’s level ≥ 4 in 34.3%, lymphovascular invasion in 1.4%, nodular histology in 2.9%, and absence of tumor-infiltrating lymphocytes in 14.4%. Fifty-three patients (7.8%) had a positive SLNB. Breslow thickness and mitotic rate independently predicted SLNB positivity. The odds of positive SLNB increased by 50% for each 0.1 mm increase in thickness past 0.7 mm (95% confidence interval [CI] 1.05–2.13) and by 22% for each mitosis per mm2 (95% CI 1.06–1.41). Patients who had one excised node (vs. two or more) were three times less likely to have a positive SLNB (3.6% vs. 9.6%; odds ratio 2.9 [1.3–7.7]).

Conclusions

Our international multi-institutional data confirm that Breslow thickness and mitotic rate independently predict SLNB positivity in patients with T1 melanoma. Even within this highly selected population, the number needed to diagnose is 13:1 (7.8%), indicating that more work is required to identify additional predictors of sentinel node positivity.

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Funding

No sources of funding were received to assist in the preparation of this study.

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Authors and Affiliations

  1. Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Richard J. B. Walker MD, Nicole J. Look Hong MD, MSc & Frances C. Wright MD, MEd

  2. Department of Plastic & Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, UK

    Marc Moncrieff MD, FRCS(Plast.)

  3. Melanoma Institute Australia, The University of Sydney and Royal Prince Alfred Hospital, Sidney, Australia

    Alexander C. J. van Akkooi MD, PhD

  4. Department of Surgery, Foothills Medical Centre, Calgary, AB, Canada

    Evan Jost MD, May Lynn Quan MD, MSc & J. Gregory McKinnon MD

  5. Department of Surgery, The Ottawa Hospital, OHRI, Ottawa, ON, Canada

    Carolyn Nessim MD, MSc & Chanhee Seo BSc

  6. Department of Surgery, Netherlands Cancer Institute – Antoni van Leeuwenhoek, Amsterdam, The Netherlands

    Winan J. van Houdt MD, MSc, PhD & Emma H. A. Stahlie MD

  7. Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Michail N. Mavros MD

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  1. Richard J. B. Walker MD
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Correspondence to Michail N. Mavros MD.

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Disclosure

Carolyn Nessim has received honoraria for participation in advisory boards from Merck, Novartis, EMD Sorono, and Sanofi. Frances C. Wright has received honoraria from Novartis. Richard J.B. Walker, Nicole J. Look Hong, Marc Moncrieff, Alexander C.J. van Akkooi, Evan Jost, Winan J. van Houdt, Emma H.A. Stahlie, Chanhee Seo, May Lynn Quan, J. Gregory McKinnon, and Michail N. Mavros have no conflicts of interest to declare.

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Walker, R.J.B., Look Hong, N.J., Moncrieff, M. et al. Predictors of Sentinel Lymph Node Metastasis in Patients with Thin Melanoma: An International Multi-institutional Collaboration. Ann Surg Oncol 29, 7010–7017 (2022). https://doi.org/10.1245/s10434-022-11936-z

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