Should Sentinel Lymph Node Biopsy Be Performed for All T1b Melanomas in the New 8^th Edition American Joint Committee on Cancer Staging System? - 17/03/19

Doi : 10.1016/j.jamcollsurg.2018.12.030

Michael E. Egger, MD, MPH ^a,^⁎ , Megan Stevenson, MD ^a, Neal Bhutiani, MD, PhD ^a, Adrienne C. Jordan, MD ^b, Charles R. Scoggins, MD, MBA, FACS ^a, Prejesh Philips, MBBS, FACS ^a, Robert CG. Martin, MD, PhD, FACS ^a, Kelly M. McMasters, MD, PhD, FACS ^a
^a Hiram C Polk Jr, MD, Department of Surgery, University of Louisville, Louisville, KY
^b Department of Pathology and Laboratory Medicine, University of Louisville, Louisville, KY

^∗Correspondence address: Michael E Egger, MD, MPH, Hiram C Polk Jr, MD, Department of Surgery, University of Louisville, 315 E Broadway, M-10, Louisville, KY 40202.Hiram C Polk Jr, MDDepartment of SurgeryUniversity of Louisville315 E Broadway, M-10LouisvilleKY40202

Abstract

Background

In the 8^th edition of the American Joint Committee on Cancer melanoma staging system, the T1b category has been redefined based solely on thickness and ulceration. National Comprehensive Cancer Network guidelines recommend consideration of sentinel lymph node biopsy (SLNB) for all patients with T1b melanomas (0.8 to 1.0 mm thick). We hypothesized that the new staging system would lead to excessive use of SLNB in patients with non-ulcerated T1b melanomas with a low risk of positive sentinel lymph nodes.

Study Design

The National Cancer Database 2015 Melanoma Public Use File was used to select patients undergoing SLNB for thin T1 cutaneous melanoma from 2010 to 2015. Clinicopathologic risk factors for having a positive SLNB were evaluated. Univariable and multivariable logistic regression models and classification and regression tree analysis were performed to identify groups with high and low risk of positive SLNB.

Results

We selected patients undergoing SLNB without ulceration with thickness 0.75 to 1.04 mm, staged T1b in the new 8^th edition American Joint Committee on Cancer by thickness criteria alone (6,894 patients). Independent risk factors for a positive sentinel lymph node were age 56 years or younger (odds ratio [OR] 1.74; 95% CI 1.38 to 2.17), thickness 1.0 vs 0.8 to 0.9 mm (OR 1.36; 95% CI 1.09 to 1.70), female sex (OR 1.36; 95% CI 1.09 to 1.69), and mitotic rate ≥1/mm² (OR 2.01; 95% CI 1.54 to 2.64). Classification and regression tree analysis identified 2 groups based on age, mitotic rate, and thickness with a risk of positive SLNB <5%. These 2 groups made up 55% of T1b, nonulcerated melanoma patients who underwent SLNB.

Conclusions

The new 8^th edition American Joint Committee on Cancer melanoma staging system T1b category should not be used to determine use of SLNB in thin melanoma, as more than one half of T1b lesions without ulceration have a low risk of positive sentinel lymph nodes.

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Abbreviations and Acronyms : AJCC, CART, MR, NCDB, SLN

Plan

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	Disclosure Information: Authors have nothing to disclose. Timothy J Eberlein, Editor-in-Chief, has nothing to disclose.