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Journal of the American Academy of Dermatology
Volume 74, n° 1
pages 94-101 (janvier 2016)
Doi : 10.1016/j.jaad.2015.09.014
accepted : 9 September 2015
Original Articles

A retrospective, multicenter analysis of the predictive value of mitotic rate for sentinel lymph node (SLN) positivity in thin melanomas
 

Heidi Wat, MD a, Ambikaipakan Senthilselvan, PhD b, Thomas G. Salopek, MD, FRCPC a,
a Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada 
b Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada 

Correspondence to: Thomas G. Salopek, MD, FRCPC, University of Alberta Dermatology Center, 2-144 Clinical Sciences Bldg, Edmonton, Alberta, T6G 2G3, Canada.
Abstract
Background

There is a paucity of studies to substantiate whether the presence of a single mitosis justifies sentinel lymph node (SLN) biopsy (SLNB) in thin melanomas.

Objective

We sought to determine if mitotic rate is associated with SLNB outcome when taking into account other prognostic factors.

Methods

All cases of melanoma that underwent SLNB in the province of Alberta, Canada, between 2007 and 2013 were reviewed through a provincial tumor database.

Results

A total of 1072 patients fulfilled inclusion criteria. When analyzing all melanomas regardless of thickness, mitotic rate was a good predictor of SLN status. When stratified by Breslow thickness, only intermediate melanomas (1.01-2.0 mm) demonstrated a significant relationship between mitotic rate and positive SLN status (P  = .010). For melanomas 1 mm or smaller, mitotic rate was not associated with SLN status. A statistically significant interaction was identified between Breslow thickness and mitotic rate such that for decreasing Breslow depth, the effect of mitotic rate on SLNB status diminished (P  = .028).

Limitations

The study was retrospective in nature. There is underlying variability in mitotic rate reporting methods over time, and between different dermatopathologists.

Conclusions

Mitotic rate does not have unequivocal utility in predicting SLNB status in thin melanomas. There is a significant interaction between mitotic rate and Breslow depth, such that the predictive value of mitotic rate on SLN positivity may be dependent on Breslow thickness.

The full text of this article is available in PDF format.

Key words : breslow thickness, cutaneous neoplasm, lymphadenectomy, melanoma, mitotic figure, mitotic index, mitotic rate, prognosis, sentinel lymph node biopsy, sentinel node, staging, thin melanoma, tumors

Abbreviations used : AJCC, SLN, SLNB



 Funding sources: None.
 Disclosure: Dr Salopek has received honoraria from Galderma, Leo, Valeant, AbbVie, Janssen, Amgen, Roche, Merck, and Actelion for serving as an advisory board member. Drs Wat and Senthilselvan have no conflicts of interest to declare.
 Reprints not available from the authors.



© 2015  American Academy of Dermatology, Inc.@@#104156@@
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