BackgroundSentinel lymph node biopsy in thin invasive primary cutaneous melanoma (up to
1mm thick) is a controversial subject. The presence of tumor-infiltrating
lymphocytes could be a factor to be considered in the decision to perform
this procedure.ObjectiveTo evaluate the association between the presence of tumor-infiltrating
lymphocytes and lymph node metastases caused by thin primary cutaneous
melanoma.MethodsCross-sectional study with 137 records of thin invasive primary cutaneous
melanoma submitted to sentinel lymph node biopsy from 2003 to 2015. The
clinical variables considered were age, sex and topography of the lesion.
The histopathological variables assessed were: tumor-infiltrating
lymphocytes, melanoma subtype, Breslow thickness, Clark levels, number of
mitoses per mm2, ulceration, regression and satellitosis.
Univariate analyzes and logistic regression tests were performed as well the
odds ratio and statistical relevance was considered when p <0.05.ResultsAmong the 137 cases of thin primary cutaneous melanoma submitted to sentinel
lymph node biopsy, 10 (7.3%) had metastatic involvement. Ulceration on
histopathology was positively associated with the presence of metastatic
lymph node, with odds ratio =12.8 (2.77-59.4 95% CI, p=0.001). The presence
of moderate/marked tumor-infiltrating lymphocytes was shown to be a
protective factor for the presence of metastatic lymph node, with OR=0.20
(0.05-0.72 95% CI, p=0.014). The other variables - clinical and
histopathological - were not associated with the outcome.Study limitationsThe relatively small number of positive sentinel lymph node biopsy may
explain such an expressive association of ulceration with
metastatization.ConclusionsIn patients with thin invasive primary cutaneous melanoma, few or absent
tumor-infiltrating lymphocytes, as well as ulceration, represent independent
risk factors for lymph node metastasis.
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