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

01-06-2005

Sentinel Lymph Node Tumor Load: An Independent Predictor of Additional Lymph Node Involvement and Survival in Melanoma

Authors: Ronald J. C. L. M. Vuylsteke, MD, Paul J. Borgstein, MD, PhD, Paul A. M. van Leeuwen, MD, PhD, Hester A. Gietema, MD, Barbara G. Molenkamp, MD, Markwin G. Statius Muller, MD, PhD, Paul J. van Diest, MD, PhD, Joost R. M. van der Sijp, MD, PhD, Sybren Meijer, MD, PhD

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

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Abstract

Background

Even though 60% to 80% of melanoma patients with a positive sentinel lymph node (SLN) have no positive additional lymph nodes (ALNs), all these patients are subjected to an ALN dissection (ALND) with its associated morbidity. The aim of this study was to predict the absence of ALN metastases in patients with a positive SLN by using features of the primary melanoma and SLN tumor load.

Methods

Of 71 SLN-positive patients, 52 had metastasis limited to the SLN (group 1), and 19 had ≥1 positive ALN after ALND (group 2). The tumor load of the SLN was assessed by measuring the total surface area by computerized morphometry. Breslow thickness, ulceration and lymphatic invasion of the primary tumor, and total SLN metastatic area were tested as covariates predicting the absence of positive ALNs.

Results

The mean SLN metastatic area was 1.18 mm2 (group 1) and 3.39 mm2 (group 2) (P = .003) and was the only significant and independent factor after multivariate analysis (P = .02). None of the patients with both a Breslow thickness <2.5 mm and an SLN metastatic area <.3 mm2 had a positive ALN.

Conclusions

SLN metastatic area can be used to predict the absence of positive ALNs in melanoma patients. In this study, patients with a Breslow thickness <2.5 mm and an SLN tumor load <.3 mm2 seemed to have no positive ALN and had excellent survival. We hypothesize that this subgroup might not benefit from ALND. Prospective larger trials, using this model and randomizing between ALND and no ALND, should confirm this hypothesis.
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Metadata
Title
Sentinel Lymph Node Tumor Load: An Independent Predictor of Additional Lymph Node Involvement and Survival in Melanoma
Authors
Ronald J. C. L. M. Vuylsteke, MD
Paul J. Borgstein, MD, PhD
Paul A. M. van Leeuwen, MD, PhD
Hester A. Gietema, MD
Barbara G. Molenkamp, MD
Markwin G. Statius Muller, MD, PhD
Paul J. van Diest, MD, PhD
Joost R. M. van der Sijp, MD, PhD
Sybren Meijer, MD, PhD
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.2005.06.013

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