Top

Published in:

01-05-2007 | Melanomas

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

Authors: Giorgos C. Karakousis, MD, 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

Published in: Annals of Surgical Oncology | Issue 5/2007

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.

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

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

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; 5:255–60PubMed

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 311–3PubMed

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; 8:209–14PubMedCrossRef

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

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

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; 7:262–7PubMedCrossRef

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; 17:976–83PubMed

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 547–8PubMedCrossRef

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; 12:449–58PubMedCrossRef

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; 11:247–58PubMedCrossRef

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; 36:347–50PubMed

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; 130:151–6PubMedCrossRef

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; 89:453–62PubMedCrossRef

16.

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

17.

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

18.

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

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; 22:3668–76PubMedCrossRef

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; 98:1223–31PubMedCrossRef

21.

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

22.

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

23.

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

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; 10:569–74PubMedCrossRef

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; 11:900–6PubMedCrossRef

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; 149:662–3PubMedCrossRef

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; 19:3635–48PubMed

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; 19:3622–34PubMed

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; 22:3660–7PubMedCrossRef

Title: 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
Authors: Giorgos C. Karakousis, MD
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
Publication date: 01-05-2007
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 5/2007
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-006-9319-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2007

Review of Distribution of Nodal Disease in Differentiated Thyroid Cancers in an Oncosurgical Center in Sri Lanka

Magnetic Resonance–Guided Focused Ultrasound Surgery for the Noninvasive Curative Ablation of Tumors and Palliative Treatments: A Review

Local Recurrence in Soft Tissue Sarcoma: More About the Tumor, Less About the Surgeon

Factors Affecting Successful Breast Conservation for Ductal Carcinoma in Situ

Prognostic Significance of Level and Number of Lymph Node Metastases in Patients with Gastric Cancer

Diffusion of Surgical Techniques in Early Stage Breast Cancer: Variables Related to Adoption and Implementation of Sentinel Lymph Node Biopsy