Top

European Journal of Nuclear Medicine and Molecular Imaging

Published in:

01-04-2012 | Original Article

Prognostic value of sentinel lymph node biopsy in 121 low-risk melanomas (tumour thickness <1.00 mm) on the basis of a long-term follow-up

Authors: Torsten Hinz, Hojjat Ahmadzadehfar, Anja Wierzbicki, Tobias Höller, Jörg Wenzel, Hans-Jürgen Biersack, Thomas Bieber, Monika-H. Schmid-Wendtner

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 4/2012

Abstract

Purpose

Sentinel lymph node biopsy (SLNB) is a widely accepted procedure to accurately stage melanomas with a thickness ≥1 mm. The value of SLNB in thin melanomas is still controversial, especially because long-term observations of these patients are rare. The purpose of the current study was to identify the positive sentinel lymph node (SLN) ratio in low-risk patients with cutaneous melanoma (CM) of thickness less than 1 mm and its possible prognostic value, focusing on long-term follow-up data.

Methods

In a retrospective single-centre study performed at the Department of Dermatology and Allergy, University of Bonn, 121 patients who had received SLNB were identified out of 621 patients with a diagnosis of CM of <1.00 mm thickness presenting between September 2000 and February 2009 (mean follow-up time, 50.9 months).

Results

Of the 121 patients, 5 (4.1%) had a positive SLN. All positive SLNs were found in patients with a tumour thickness between 0.90 mm and 1.00 mm. There were no significant differences in the presence of positive SLNs according to Clark level and ulceration status (Clark levels II and III and no ulceration vs. Clark levels IV and V or ulceration), regression, gender or age. Disease-free survival was 100% in the SLN-positive patients. On the other hand, five SLN-negative patients (4.1%) developed disease progression. One of these five progressive patients showed recurrence in the former negative SLN basin (16.7% false-negative rate).

Conclusion

A positive SLN in thin melanomas is uncommon with a prevalence of 4.1% in our study population. We could not identify reliable clinicopathological risk factors which could predict results of SLNB in thin melanomas. Based on our results, SLNB may be considered in patients with a melanoma of thickness in the range 0.90–0.99 mm, because all SLN-positive patients belonged to this subgroup.

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

Balch CM, Gershenwald JE, Soong S, Thompson JF, Atkins MB, Byrd DR, et al. Final version of 2009 AJCC Melanoma Staging and Classification. J Clin Oncol. 2009;27:6199–206.PubMedCrossRef

Cascinelli N, Morabito A, Santinami M, MacKie RM, Belli F. Immediate or delayed dissection of regional nodes in patients with melanoma of the trunk: a randomised trial. WHO Melanoma Programme. Lancet. 1998;351:793–6.PubMedCrossRef

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

Ross MI, Gershenwald JE. How should we view the results of the Multicenter Selective Lymphadenectomy Trial-1 (MSLT-1)? Ann Surg Oncol. 2008;15:670–3.PubMedCrossRef

Gershenwald JE, Thompson W, Mansfield PF, Lee JE, Colome MI, Tseng CH, 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;17:976–83.PubMed

Vuylsteke RJ, van Leeuwen PA, Statius Muller MG, Gietema HA, Kragt DR, Meijer S. Clinical outcome of stage I/II melanoma patients after selective sentinel lymph node dissection: long term follow-up results. J Clin Oncol. 2003;21:1057–65.PubMedCrossRef

Agnese DM, Abdessalam SF, Burak WE, Magro CM, Pozderac RV, Walker MJ. Cost-effectiveness of sentinel lymph node biopsy in thin melanomas. Surgery. 2003;134:542–7.PubMedCrossRef

Statius Muller MG, van Leeuwen PA, van Diest PJ, Vuylsteke RJ, Pijpers R, Meijer S. No indication for performing sentinel lymph node biopsy in melanoma patients with a Breslow thickness of less than 0.9 mm. Melanoma Res. 2001;11:303–7.PubMedCrossRef

10.

Balch CM, Murad TM, Soong SJ, Ingalls AL, Halpern NB, Maddox WA. A multifactorial analysis of melanoma: prognostic histopathologic factors comparing Clark’s and Breslow’s staging methods. Ann Surg. 1978;188:732–42.PubMedCrossRef

11.

Breslow A, Macht SD. Evaluation of prognosis in stage I cutaneous melanoma. Plast Reconstr Surg. 1978;61:342–6.PubMedCrossRef

12.

Gimotty PA, Guerry D, Ming ME, Elenitsas R, Xu X, Czerniecki B, 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;22:3668–76.PubMedCrossRef

13.

Gimotty PA, Botbyl J, Soong SJ, Guerry D. A population-based validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol. 2005;23:8065–75.PubMedCrossRef

14.

Garbe C, Paul A, Kohler-Späth H, Ellwanger U, Stroebel W, Schwarz M, et al. Prospective evaluation of a follow-up schedule in cutaneous melanoma patients: recommendations for an effective follow-up strategy. J Clin Oncol. 2003;21:520–9.PubMedCrossRef

15.

Balch CM. Cutaneous melanoma: prognosis and treatment results worldwide. Semin Surg Oncol. 1992;8:400–14.PubMedCrossRef

16.

Carlson GW, Murray DR, Lyles RH, Staley CA, Hestley A, Cohen C. The amount of metastatic melanoma in a sentinel lymph node: does it have prognostic significance? Ann Surg Oncol. 2003;10:575–81.PubMedCrossRef

17.

Spanknebel K, Coit DG, Bieligk SC, Gonen M, Rosai J, Klimstra DS. Characterization of micrometastatic disease in melanoma sentinel lymph nodes by enhanced pathology: Recommendations for standardizing pathologic analysis. Am J Surg Pathol. 2005;29:305–17.PubMedCrossRef

18.

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;98:1223–31.PubMedCrossRef

19.

Schmid-Wendtner MH, Baumert J, Schmidt M, Konz B, Hölzel D, Plewig G, et al. Late metastases of cutaneous melanoma: an analysis of 31 patients. J Am Acad Dermatol. 2000;43:605–9.PubMedCrossRef

20.

Stitzenberg KB, Groben PA, Stern SL, Thomas NE, Hensing TA, Sansbury LB, et al. Indications for lymphatic mapping and sentinel lymphadenectomy in patients with thin melanoma (Breslow thickness < or = 1.0 mm). Ann Surg Oncol. 2004;11:900–6.PubMedCrossRef

21.

Oliveira Filho RS, Ferreira LM, Biasi LJ, Enokihara MM, Paiva GR, Wagner J. Vertical growth phase and positive sentinel node in thin melanoma. Braz J Med Biol Res. 2003;36:347–50.PubMedCrossRef

22.

Rousseau Jr DL, Ross MI, Johnson MM, Prieto VG, Lee JE, Mansfield PF, 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;10:569–74.PubMedCrossRef

23.

Puleo CA, Messina JL, Riker AI, Glass LF, Nelson C, Cruse CW, et al. Sentinel node biopsy for thin melanomas: which patient should be considered? Cancer Control. 2005;12:230–5.PubMed

24.

Lens MB, Dawes M, Newton-Bishop JA, Goodacre T. Tumour thickness as a predictor of occult lymph node metastases in patients with stage I and II melanoma undergoing sentinel lymph node biopsy. Br J Surg. 2002;89:1223–7.PubMedCrossRef

25.

Wong SL, Brady MS, Coit DG, et al. Results of sentinel lymph node biopsy in thin melanoma. Presented at the 4th Biennial International Sentinel Node Congress, Los Angeles, CA, 3–6 December 2004.

26.

Olah J, Gyulai R, Korom I, Varga E, Dobozy A. Tumor regression predicts higher risk of sentinel node involvement in thin cutaneous melanomas. Br J Dermatol. 2003;149:662–3.PubMedCrossRef

27.

Sekula-Gibbs SA, Shearer MA. Sentinel node biopsy should be offered in thin melanoma with mitotic rate greater than one. Dermatol Surg. 2011;37:1080–8.PubMedCrossRef

28.

Garbe C, Eigentler TK, Bauer J, Blödorn-Schlicht N, Fend F, Hantschke M, et al. Histopathological diagnostics of malignant melanoma in accordance with the recent AJCC classification 2009: Review of the literature and recommendations for general practice. J Dtsch Dermatol Ges. 2011;9:690–700.PubMed

29.

Bleicher RJ, Essner R, Foshag IJ, Wanek LA, Morton DL. Role of sentinel lymphadenectomy in thin invasive cutaneous melanomas. J Clin Oncol. 2003;21:1326–31.PubMedCrossRef

30.

Jacobs IA, Chang CK, DasGupta TK, Salti GI. Role of sentinel lymph node biopsy in patients with thin primary melanoma. Ann Surg Oncol. 2003;10:558–61.PubMedCrossRef

31.

Warycha MA, Zakrzewski J, Ni Q, Shapiro RL, Berman RS, Pavlick AC, et al. Meta-analysis of sentinel lymph node positivity in thin melanoma (< or =1 mm). Cancer. 2009;115:869–79.PubMedCrossRef

32.

Zapas JL, Coley HC, Beam SL, Brown SD, Jablonski KA, Elias EG. The risk of regional lymph node metastases in patients with melanoma less than 1.0 mm thick: recommendation for sentinel lymph node biopsy. J Am Coll Surg. 2003;197:403–7.PubMedCrossRef

33.

Miller MW, Vetto JT, Monroe MM, Weerasinghe R, Andersen PE, Gross ND. False-negative sentinel lymph node biopsy in head and neck melanoma. Otolaryngol Head Neck Surg. 2011;145:606–11.PubMedCrossRef

34.

Gadd MA, Cosimi AB, Yu J, Duncan LM, Yu L, Flotte TJ, et al. Outcome of patients with melanoma and histological negative sentinel lymph nodes. Arch Surg. 1999;134:381–7.PubMedCrossRef

35.

Panasiti V, Devirgiliis V, Curzio M, Roberti V, Gobbi S, Rossi M, et al. Predictive factors for false negative sentinel lymph node in melanoma patients. Dermatol Surg. 2010;36:1521–8.PubMedCrossRef

36.

Statius Muller MG, Borgstein PJ, Pijpers R, van Leeuwen PA, van Diest PJ, Gupta A, et al. Reliability of the sentinel node procedure in melanoma patients: analysis of failures after long-term follow up. Ann Surg Oncol. 2000;7:461–8.PubMedCrossRef

37.

Gershenwald JE, Colome MI, Lee JE, Mansfield PF, Tseng C, Lee JJ, et al. Patterns of recurrence following a negative sentinel lymph node biopsy in 243 patients with stage I or II melanoma. J Clin Oncol. 1998;16:2253–60.PubMed

38.

Wrightson WR, Wong SL, Edwards MJ, Chao C, Reintgen DS, Ross MI, et al. Complications associated with sentinel lymph node biopsy for melanoma. Ann Surg Oncol. 2003;10:676–80.PubMedCrossRef

Title: Prognostic value of sentinel lymph node biopsy in 121 low-risk melanomas (tumour thickness <1.00 mm) on the basis of a long-term follow-up
Authors: Torsten Hinz
Hojjat Ahmadzadehfar
Anja Wierzbicki
Tobias Höller
Jörg Wenzel
Hans-Jürgen Biersack
Thomas Bieber
Monika-H. Schmid-Wendtner
Publication date: 01-04-2012
Publisher: Springer-Verlag
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 4/2012
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-011-2009-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prognostic value of sentinel lymph node biopsy in 121 low-risk melanomas (tumour thickness <1.00 mm) on the basis of a long-term follow-up

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2012

Therapeutic efficacy and toxicity of 225Ac-labelled vs. 213Bi-labelled tumour-homing peptides in a preclinical mouse model of peritoneal carcinomatosis

Minimally invasive input function for 2-18F-fluoro-A-85380 brain PET studies

Measuring glomerular filtration rate from plasma clearance of 51Cr-EDTA: quality assurance

Multimodality Imaging Training Curriculum — Parts II and III

Effect of stress testing on left ventricular mechanical synchrony by phase analysis of gated positron emission tomography in patients with normal myocardial perfusion

Correlation of early-phase 18F-florbetapir (AV-45/Amyvid) PET images to FDG images: preliminary studies