Top

Published in:

01-06-2005

Mitotic Rate as a Predictor of Sentinel Lymph NodePositivity in Patients With Thin Melanomas

Authors: Susan B. Kesmodel, MD, Giorgos C. Karakousis, MD, Jeffrey D. Botbyl, MS, Robert J. Canter, MD, Robert T. Lewis, BA, Peter M. Wahl, BA, Kyla P. Terhune, MD, Abass Alavi, MD, David E. Elder, MB, ChB, Michael E. Ming, MD, MSCE, DuPont Guerry, MD, Phyllis A. Gimotty, PhD, Douglas L. Fraker, MD, Brian J. Czerniecki, MD, PhD, Francis R. Spitz, MD

Published in: Annals of Surgical Oncology | Issue 6/2005

Abstract

Background

Lymphatic mapping and sentinel lymphadenectomy (LM/SL) provide important prognostic information for patients with early-stage melanoma. Although the use of this technique in patients with thin melanomas (≤1.00 mm) is not routine, risk factors that may predict sentinel lymph node (SLN) positivity in this patient population are under investigation. We sought to determine whether mitotic rate (MR) is associated with SLN positivity in thin-melanoma patients and, therefore, whether it may be used to risk-stratify and select patients for LM/SL.

Methods

Clinical and histopathologic variables were reviewed for 181 patients with thin melanomas who underwent LM/SL from January 1996 through January 2004. Univariate and multivariate logistic regression analyses were performed to identify factors associated with SLN positivity. Risk groups were defined on the basis of the development of a classification tree.

Results

The overall SLN positivity rate was 5%. All patients with positive SLNs had an MR of >0. By univariate analysis, MR and thickness were significant predictors of SLN positivity. The association between MR and SLN positivity remained significant controlling for each of the other variables evaluated. On the basis of a classification tree, patients with an MR >0 and tumor thickness ≥.76 mm were identified as a higher-risk group, with an SLN positivity rate of 12.3%.

Conclusions

In patients with thin melanomas, MR >0 seems to be a significant predictor of SLN positivity that may be used to risk-stratify and select patients for LM/SL. To confirm these results, the predictive value of MR for SLN positivity needs to be validated in other populations of thin-melanoma patients.

Morton, DL, Wen, DR, Wong, JH, et al. 1992Technical details of intraoperative lymphatic mapping for early stage melanomaArch Surg1273929PubMed

Gershenwald, JE, Thompson, W, Mansfield, PF, et al. 1999Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patientsJ Clin Oncol1797683PubMed

Albertini, JJ, Cruse, CW, Rapaport, D, et al. 1996Intraoperative radio-lympho-scintigraphy improves sentinel lymph node identification for patients with melanomaAnn Surg 22321724CrossRefPubMed

Essner, R, Conforti, A, Kelley, MC, et al. 1999Efficacy of lymphatic mapping, sentinel lymphadenectomy, and selective complete lymph node dissection as a therapeutic procedure for early-stage melanomaAnn Surg Oncol64429CrossRefPubMed

Jansen, L, Nieweg, OE, Peterse, JL, Hoefnagel, CA, Olmos, RA, Kroon, BB 2000Reliability of sentinel lymph node biopsy for staging melanomaBr J Surg874849CrossRefPubMed

Morton, DL, Thompson, JF, Essner, R, et al. 1999Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: a multicenter trial. Multicenter Selective Lymphadenectomy Trial GroupAnn Surg23045363discussion 463–5CrossRefPubMed

Reintgen, D, Cruse, CW, Wells, K, et al. 1994The orderly progression of melanoma nodal metastasesAnn Surg22075967PubMed

Balch, CM, Soong, SJ, Gershenwald, JE, et al. 2001Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging systemJ Clin Oncol19362234

Clary, BM, Brady, MS, Lewis, JJ, Coit, DG 2001Sentinel lymph node biopsy in the management of patients with primary cutaneous melanoma: review of a large single-institutional experience with an emphasis on recurrenceAnn Surg2332508CrossRefPubMed

10.

Cascinelli, N, Belli, F, Santinami, M, et al. 2000Sentinel lymph node biopsy in cutaneous melanoma: the WHO Melanoma Program experienceAnn Surg Oncol746974CrossRefPubMed

11.

Bleicher, RJ, Essner, R, Foshag, LJ, Wanek, LA, Morton, DL 2003Role of sentinel lymphadenectomy in thin invasive cutaneous melanomasJ Clin Oncol21132631CrossRefPubMed

12.

Joseph, E, Brobeil, A, Glass, F, et al. 1998Results of complete lymph node dissection in 83 melanoma patients with positive sentinel nodesAnn Surg Oncol511925PubMed

13.

Roses, DF, Harris, MN, Hidalgo, D, Valensi, QJ, Dubin, N 1982Primary melanoma thickness correlated with regional lymph node metastasesArch Surg1179213PubMed

14.

Nguyen, CL, McClay, EF, Cole, DJ, et al. 2001Melanoma thickness and histology predict sentinel lymph node statusAm J Surg181811CrossRefPubMed

15.

Agnese, DM, Abdessalam, SF, Burak, WE,Jr, Magro, CM, Pozderac, RV, Walker, MJ 2003Cost-effectiveness of sentinel lymph node biopsy in thin melanomasSurgery1345427discussion 547–8CrossRefPubMed

16.

Jacobs, IA, Chang, CK, DasGupta, TK, Salti, GI 2003Role of sentinel lymph node biopsy in patients with thin (<1 mm) primary melanomaAnn Surg Oncol1055861CrossRefPubMed

17.

Bedrosian, I, Faries, MB, Guerry, DT, et al. 2000Incidence of sentinel node metastasis in patients with thin primary melanoma (≤ 1 mm) with vertical growth phaseAnn Surg Oncol 72627CrossRefPubMed

18.

Balch, CM, Buzaid, AC, Soong, SJ, et al. 2001Final version of the American Joint Committee on Cancer staging system for cutaneous melanomaJ Clin Oncol19363548

19.

Gimotty, PG, Guerry, D, Ming, ME, et al. 2004Thin primary cutaneous malignant melanoma: a prognostic tree for ten-year metastasis is more accurate than AJCC stagingJ Clin Oncol22366876CrossRefPubMed

20.

Clark, WH,Jr, Elder, DE, Guerry, DT, et al. 1989Model predicting survival in stage I melanoma based on tumor progressionJ Natl Cancer Inst811893904PubMed

21.

Clark, WH,Jr, From, L, Bernardino, EA, Mihm, MC 1969The histogenesis and biologic behavior of primary human malignant melanomas of the skinCancer Res2970527PubMed

22.

Spatz, A, Cook, MG, Elder, DE, Piepkorn, M, Ruiter, DJ, Barnhill, RL 2003Interobserver reproducibility of ulceration assessment in primary cutaneous melanomasEur J Cancer3918615CrossRefPubMed

23.

Morton, DL 2001Lymphatic mapping and sentinel lymphadenectomy for melanoma: past, present, and futureAnn Surg Oncol822S28SPubMed

24.

McMasters, KM, Wong, SL, Edwards, MJ, et al. 2001Factors that predict the presence of sentinel lymph node metastasis in patients with melanomaSurgery1301516CrossRefPubMed

25.

Slingluff, CL,Jr, Vollmer, RT, Reintgen, DS, Seigler, HF 1988Lethal “thin” malignant melanomaIdentifying patients at risk. Ann Surg20815061

26.

Johnson, OK,Jr, Emrich, LJ, Karakousis, CP, Rao, U, Greco, WR 1985Comparison of prognostic factors for survival and recurrence in malignant melanoma of the skin, clinical stage ICancer55110717PubMed

27.

Schuchter, L, Schultz, DJ, Synnestvedt, M, et al. 1996A prognostic model for predicting 10-year survival in patients with primary melanoma. The Pigmented Lesion GroupAnn Intern Med12536975PubMed

28.

Sondak, VK, Taylor, JM, Sabel, MS, et al. 2004Mitotic rate and younger age are predictors of sentinel lymph node positivity: lessons learned from the generation of a probabilistic modelAnn Surg Oncol1124758CrossRefPubMed

29.

Thompson, JF, Shaw, HM 2004Editorial: should tumor mitotic rate and patient age, as well as tumor thickness, be used to select melanoma patients for sentinel node biopsy?Ann Surg Oncol112335CrossRefPubMed

30.

Wagner, JD, Gordon, MS, Chuang, TY, et al. 2000Predicting sentinel and residual lymph node basin disease after sentinel lymph node biopsy for melanomaCancer8945362CrossRefPubMed

31.

Mraz-Gernhard, S, Sagebiel, RW, Kashani-Sabet, M, Miller, JR,III, Leong, SP 1998Prediction of sentinel lymph node micrometastasis by histological features in primary cutaneous malignant melanomaArch Dermatol1349837CrossRefPubMed

32.

Rousseau, DL,Jr, Ross, MI, Johnson, MM, et al. 2003Revised American Joint Committee on Cancer staging criteria accurately predict sentinel lymph node positivity in clinically node-negative melanoma patientsAnn Surg Oncol 1056974CrossRefPubMed

33.

Surveillance, Epidemiology, and End Results (SEER) Program Public-Use Data (1973–2000), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch; http://www.seer.cancergov; released April 2003, based on the November 2002 submission

34.

Corsetti, RL, Allen, HM, Wanebo, HJ 2000Thin < or = 1 mm level III and IV melanomas are higher risk lesions for regional failure and warrant sentinel lymph node biopsyAnn Surg Oncol745660CrossRefPubMed

35.

Azzola, MF, Shaw, HM, Thompson, JF, et al. 2003Tumor mitotic rate is a more powerful prognostic indicator than ulceration in patients with primary cutaneous melanoma: an analysis of 3661 patients from a single centerCancer97148898CrossRefPubMed

Title: Mitotic Rate as a Predictor of Sentinel Lymph NodePositivity in Patients With Thin Melanomas
Authors: Susan B. Kesmodel, MD
Giorgos C. Karakousis, MD
Jeffrey D. Botbyl, MS
Robert J. Canter, MD
Robert T. Lewis, BA
Peter M. Wahl, BA
Kyla P. Terhune, MD
Abass Alavi, MD
David E. Elder, MB, ChB
Michael E. Ming, MD, MSCE
DuPont Guerry, MD
Phyllis A. Gimotty, PhD
Douglas L. Fraker, MD
Brian J. Czerniecki, MD, PhD
Francis R. Spitz, MD
Publication date: 01-06-2005
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 6/2005
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/ASO.2005.04.027

2024 ASCO Annual Meeting

Springer Medicine

Mitotic Rate as a Predictor of Sentinel Lymph NodePositivity in Patients With Thin Melanomas

Abstract

Background

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2005

Outcome in 846 Cutaneous Melanoma Patients From a Single Center After a Negative Sentinel Node Biopsy

Quality of Life and Functional Long-Term Outcome After Partial Pancreatoduodenectomy: Pancreatogastrostomy Versus Pancreatojejunostomy

Treatment of Liver Metastases From Uveal Melanoma

Expression of the Transcription Factors Snail, Slug, and Twist and Their Clinical Significance in Human Breast Cancer

Correlation Between Concordance of Tracers, Order of Harvest, and Presence of Metastases in Sentinel Lymph Nodes With Breast Cancer

Sentinel Nodes Are Identifiable in Formalin-Fixed Specimens After Surgeon-Performed Ex Vivo Sentinel Lymph Node Mapping in Colorectal Cancer