Stratifying SLN incidence in intermediate thickness melanoma patients - 20/03/18

Doi : 10.1016/j.amjsurg.2017.12.009

James M. Chang ^a, Heidi E. Kosiorek ^b, Amylou C. Dueck ^b, Stanley P.L. Leong ^c, John T. Vetto ^d, Richard L. White ^e, Eli Avisar ^f, Vernon K. Sondak ^g, Jane L. Messina ^g, Jonathan S. Zager ^g, Carlos Garberoglio ^h, Mohammed Kashani-Sabet ^c, Barbara A. Pockaj ^a,^⁎
^a Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
^b Section of Biostatistics, Mayo Clinic Arizona, Phoenix, AZ, USA
^c Center for Melanoma Research and Treatment, Department of Surgery, California Pacific Medical Center, San Francisco, CA, USA
^d Department of Surgery, Oregon Health & Science University, Portland, OR, USA
^e Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC, USA
^f Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
^g Departments of Cutaneous Oncology and Sarcoma, Moffitt Cancer Center, Tampa, FL, USA
^h Department of Surgery, Loma Linda University School of Medicine, Loma Linda, CA, USA

^∗Corresponding author. Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA.Mayo Clinic Arizona5777 E. Mayo BlvdPhoenixAZ85054USA

Abstract

Background

Guidelines for melanoma recommend sentinel lymph node biopsy (SLNB) in patients with melanomas ≥1 mm thickness. Recent single institution studies have found tumors <1.5 mm a low-risk group for positive SLNB.

Methods

A retrospective review of the Sentinel Lymph Node Working Group multicenter database identified patients with intermediate thickness melanoma (1.01–4.00 mm) who had SLNB, and assessed predictors for positive SLNB.

Results

3460 patients were analyzed, 584 (17%) had a positive SLNB. Univariate factors associated with a positive SLNB included age <60 (p < .001), tumor on the trunk/lower extremity (p < .001), Breslow depth ≥2 mm (p < .001), ulceration (p < .001), mitotic rate ≥1/mm² (p = .01), and microsatellitosis (p < .001). Multivariate analysis revealed age, location, and Breslow depth as significant predictors. Patients ≥75 with lesions 1.01–1.49 mm on the head/neck/upper extremity and 1.5–1.99 mm without high-risk features had <5% risk of SLN positivity.

Conclusions

Intermediate thickness melanoma has significant heterogeneity of SLNB positivity. Low-risk subgroups can be found among older patients in the absence of high-risk features.

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Highlights

•	Intermediate thickness melanoma has heterogeneous risk for nodal metastases.
•	Groups that are low risk for nodal metastases may be spared a sentinel lymph node biopsy.
•	Elderly patients in particular may have low risk of nodal metastases.

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Plan

Introduction

Materials and methods

Statistical analysis

Results

Patient and tumor characteristics ()

Predictive factors for a positive sentinel lymph node biopsy ()

Commercial interests/disclosures

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Vol 215 - N° 4

P. 699-706 - avril 2018 Retour au numéro

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Stratifying SLN incidence in intermediate thickness melanoma patients - 20/03/18

Abstract

Background

Methods

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Highlights

Plan

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