Top

Published in:

01-12-2016 | Melanomas

The Prognostic Significance of Sentinel Lymph Node Status for Patients with Thick Melanoma

Authors: Danielle M. Bello, MD, Gang Han, PhD, Laura Jackson, BS, Kaleigh Bulloch, MPH, Stephan Ariyan, MD, Deepak Narayan, MD, Bonnie Gould Rothberg, MD, PhD, Dale Han, MD

Published in: Annals of Surgical Oncology | Special Issue 5/2016

Abstract

Background

Sentinel lymph node biopsy (SLNB) is recommended for patients with intermediate-thickness melanoma, but the use of SLNB for patients with thick melanoma is debated. This report presents a single-institution study investigating factors predictive of sentinel lymph node (SLN) metastasis and outcome for thick-melanoma patients .

Methods

A retrospective review of a single-institution database from 1997 to 2012 identified 147 patients with thick primary cutaneous melanoma (≥4 mm) who had an SLNB. Clinicopathologic characteristics were correlated with nodal status and outcome.

Results

The median age of the patients was 67 years, and 61.9 % of the patients were men. The median tumor thickness was 5.5 mm, and 54 patients (36.7 %) had a positive SLN. Multivariable analysis showed that only tumor thickness significantly predicted SLN metastasis (odds ratio 1.14; 95 % confidence interval (CI) 1.02–1.28; P = 0.02). The overall median follow-up period was 34.6 months. Overall survival (OS) and melanoma-specific survival (MSS) were significantly worse for the positive versus negative-SLN patients. Multivariable analysis showed that age [hazard ratio (HR) 1.04; 95 % CI 1.01–1.07; P = 0.02] and SLN status (HR 2.24; 95 % CI 1.03–4.88; P = 0.04) significantly predicted OS, whereas only SLN status (HR 3.85; 95 % CI 2.13–6.97; P < 0.01) significantly predicted MSS.

Conclusions

Tumor thickness predicts SLN status in thick melanomas. Furthermore, SLN status is prognostic for OS and MSS in thick-melanoma patients, with positive-SLN patients having significantly worse OS and MSS. These findings show that SLNB should be recommended for thick-melanoma patients, particularly because detection of SLN metastasis can identify patients for potential systemic therapy and treatment of nodal disease at a microscopic stage.

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65:5–29.CrossRefPubMed

Balch CM, Gershenwald JE, Soong SJ, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27:6199–206.CrossRefPubMedPubMedCentral

Morton DL, Thompson JF, Cochran AJ, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355:1307–17.CrossRefPubMed

Morton DL, Thompson JF, Cochran AJ, et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med. 2014;370:599–609.CrossRefPubMedPubMedCentral

Wong SL, Balch CM, Hurley P, et al. Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology joint clinical practice guideline. J Clin Oncol. 2012;30:2912–8.CrossRefPubMed

de Oliveira Filho RS, da Silva AM, de Oliveira DA, Oliveira GG, Nahas FX. Sentinel node biopsy should not be recommended for patients with thick melanoma. Rev Col Bras Cir. 2013;40:127–9.CrossRefPubMed

Gershenwald JE, Mansfield PF, Lee JE, Ross MI. Role for lymphatic mapping and sentinel lymph node biopsy in patients with thick (≥4 mm) primary melanoma. Ann Surg Oncol. 2000;7:160–5.CrossRefPubMed

Ferrone CR, Panageas KS, Busam K, Brady MS, Coit DG. Multivariate prognostic model for patients with thick cutaneous melanoma: importance of sentinel lymph node status. Ann Surg Oncol. 2002;9:637–45.CrossRefPubMed

Faries MB, Thompson JF, Cochran A, et al. The impact on morbidity and length of stay of early versus delayed complete lymphadenectomy in melanoma: results of the Multicenter Selective Lymphadenectomy Trial (I). Ann Surg Oncol. 2010;17:3324–9.CrossRefPubMedPubMedCentral

10.

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

11.

Ross MI, Reintgen D, Balch CM. Selective lymphadenectomy: emerging role for lymphatic mapping and sentinel node biopsy in the management of early-stage melanoma. Semin Surg Oncol. 1993;9:219–23.PubMed

12.

Gyorki DE, Sanelli A, Herschtal A, et al. Sentinel lymph node biopsy in T4 melanoma: an important risk-stratification tool. Ann Surg Oncol. 2015;23:579–84.CrossRef

13.

Yamamoto M, Fisher KJ, Wong JY, et al. Sentinel lymph node biopsy is indicated for patients with thick clinically lymph node-negative melanoma. Cancer. 2015;121:1628–36.CrossRefPubMedPubMedCentral

14.

Carlson GW, Murray DR, Hestley A, Staley CA, Lyles RH, Cohen C. Sentinel lymph node mapping for thick (≥4 mm) melanoma: should we be doing it? Ann Surg Oncol. 2003;10:408–15.CrossRefPubMed

15.

Gajdos C, Griffith KA, Wong SL, et al. Is there a benefit to sentinel lymph node biopsy in patients with T4 melanoma? Cancer. 2009;115:5752–60.CrossRefPubMed

16.

Goppner D, Ulrich J, Pokrywka A, Peters B, Gollnick H, Leverkus M. Sentinel lymph node biopsy status is a key parameter to stratify the prognostic heterogeneity of malignant melanoma in high-risk tumors >4.0 mm. Dermatology. 2011;222:59–66.CrossRefPubMed

17.

Gutzmer R, Satzger I, Thoms KM, et al. Sentinel lymph node status is the most important prognostic factor for thick (≥4 mm) melanomas. JDDG J Deutsch Dermatol Ges. 2008;6:198–203.CrossRef

18.

Thompson JF, Shaw HM. The prognosis of patients with thick primary melanomas: is regional lymph node status relevant, and does removing positive regional nodes influence outcome? Ann Surg Oncol. 2002;9:719–22.CrossRefPubMed

19.

Rughani MG, Swan MC, Adams TS, et al. Sentinel node status predicts survival in thick melanomas: the Oxford perspective. Eur J Surg Oncol. 2012;38:936–42.CrossRefPubMed

20.

Pasquali S, Haydu LE, Scolyer RA, et al. The importance of adequate primary tumor excision margins and sentinel node biopsy in achieving optimal locoregional control for patients with thick primary melanomas. Ann Surg. 2013;258:152–7.CrossRefPubMed

21.

Mozzillo N, Pennacchioli E, Gandini S, et al. Sentinel node biopsy in thin and thick melanoma. Ann Surg Oncol. 2013;20:2780–6.CrossRefPubMed

22.

Fujisawa Y, Otsuka F, Japanese Melanoma Study Group. The benefit of a sentinel lymph node biopsy and adjuvant therapy in thick (>4 mm) melanoma: multicenter, retrospective study of 291 Japanese patients. Melanoma Res. 2012;22:362–7.CrossRefPubMed

23.

Scoggins CR, Bowen AL, Martin RC II, et al. Prognostic information from sentinel lymph node biopsy in patients with thick melanoma. Arch Surg. 2010;145:622–7.CrossRefPubMed

Title: The Prognostic Significance of Sentinel Lymph Node Status for Patients with Thick Melanoma
Authors: Danielle M. Bello, MD
Gang Han, PhD
Laura Jackson, BS
Kaleigh Bulloch, MPH
Stephan Ariyan, MD
Deepak Narayan, MD
Bonnie Gould Rothberg, MD, PhD
Dale Han, MD
Publication date: 01-12-2016
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue Special Issue 5/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-016-5502-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The Prognostic Significance of Sentinel Lymph Node Status for Patients with Thick Melanoma

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 Special Issue 5/2016

Routine Level 2b Dissection may be Recommended Only in N1b Papillary Thyroid Carcinoma with Three- or Four-Level Lateral Lymph Node Metastasis

Laparoscopic Management of Gallbladder Cancer: A Stepwise Approach

Antibody-Mediated Blockade of Phosphatidylserine Enhances the Antitumor Effect of Sorafenib in Hepatocellular Carcinomas Xenografts

Cancer Survivorship: Defining the Incidence of Incisional Hernia After Resection for Intra-Abdominal Malignancy

Breast Cancer Axillary Surgery: Before, After, or None at All?

Effects of Neoadjuvant Chemotherapy Plus Radical Surgery as Front Line Treatment Strategy in Patients Affected by FIGO Stage III Cervical Cancer