Association of Histologic Regression in Primary Melanoma With Sentinel Lymph Node Status

Ribero, Simone; Gualano, Maria Rosaria; Osella‐Abate, Simona; Scaioli, Giacomo; Bert, Fabrizio; Sanlorenzo, Martina; Balagna, Elena; Fierro, Maria Teresa; Macripò, Giuseppe; Sapino, Anna; Siliquini, Roberta; Quaglino, Pietro

doi:10.1001/jamadermatol.2015.2235

Cited by 65 publications

(47 citation statements)

References 33 publications

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“…In contrast, other more recent studies have indicated that the presence of histologic regression in primary melanoma is associated with negative SLN status. 13 Thus, the prognostic impact of regression in patients with melanoma remains controversial. In this review, we discuss the various definitions and measurements of melanoma regression, the potential value of regression as a prognostic parameter, and the possible biologic mechanisms contributing to regression with the goal to promote the need for more standardized criteria for histologic assessment of regression.…”

Section: Introductionmentioning

confidence: 99%

Regression in primary cutaneous melanoma: etiopathogenesis and clinical significance

Aung

Nagarajan

Prieto

2017

Laboratory Investigation

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Though not required currently for staging, regression is a histopathologic parameter typically reported upon diagnosis of an invasive primary cutaneous melanoma. The studies examining the prognostic significance of regression in patient outcome have yielded controversial findings; likely because the definition and assessment of regression have not been consistent, in addition to subjectivity of pathologists' interpretation. Regression is histologically characterized by variable decrease in the number of melanoma cells accompanied by the presence of a host response consisting of dermal fibrosis, inflammatory infiltrate, melanophages, ectatic blood vessels, epidermal attenuation, and/or apoptosis of keratinocytes or melanocytes; the relative extent of these features depends on the stage of the regression. However, the magnitudes to which these individual changes must be present to meet the threshold of histologic regression have not been well defined or agreed upon, and thus, the definition and classification of histologic regression in melanoma varies considerably among institutions and even among individual pathologists. In order to determine the clinical significance of histologic analysis of regression, there is a compelling need for a universal scheme to objectively define and assess histologic regression in primary cutaneous melanoma, so that the biologic and prognostic significance of this process may be completely understood.

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Section: Introductionmentioning

confidence: 99%

Regression in primary cutaneous melanoma: etiopathogenesis and clinical significance

Aung

Nagarajan

Prieto

2017

Laboratory Investigation

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“…Regression has been speculated to be a possible marker of immunogenic systemic response of this survival advantage [37] . Some authors [38,39] showed that the presence of regression in the primary tumour results from a T-cell immune response associated with a decreased risk of nodal progression. To our knowledge this is the first time in which histological regression is reported as having a favourable prognostic role in trunk SLN-positive melanoma patients.…”

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confidence: 99%

Multiple Lymph Node Basin Drainage in Trunk Melanoma Is Not Associated with Survival of Sentinel Lymph Node-Positive Patients

Ribero

Abate

Pasquali³

et al. 2017

Dermatology

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Objectives: This study was aimed at investigating the prognostic role of multiple lymph node basin drainage (MLBD) in patients with positive sentinel lymph node (SLN) biopsy. Background: MLBD is frequently observed in patients with trunk melanoma undergoing SLN. The prognostic value of MLBD in SLN-positive patients is still debated. Methods: Retrospective data from 312 trunk melanoma patients with positive SLN biopsy (1991-2012) at 6 Italian referral centres were gathered in a multicentre database. MLBD was defined at preoperative lymphoscintigraphy. Clinical and pathological data were analysed for their association with disease-free interval (DFI) and disease-specific (DSS) survival. Results: MLBD was identified in 34.6% of patients (108/312) and was significantly associated with >1 positive SLN (37 vs. 15.2%; p < 0.001) and with >1 positive lymph node (LN) after complete lymph node dissection (CLND) (50.9 vs. 34.8%; p = 0.033). No differences were observed according to drainage pattern in patients who had negative and positive non-SLN at CLND. MLBD was not associated with either DFI or DSS. Multivariate analyses showed that tumour thickness, ulceration, and number of metastatic LNs were associated with worse DFI and DSS, while regression confirmed its protective role in survival. Conclusion: In positive SLN patients, MLBD has no association with survival, which is mainly related to American Joint Committee on Cancer (AJCC) prognostic factors. Since the overall number of positive LNs drives the prognosis, the importance of a CLND in all the positive basins is confirmed.

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“…One plausible hypothesis proposed by the authors is that smoking could enhance immunosuppression in the tumour microenvironment, favouring disease spread . In melanoma, the association between the presence of histologic regression or the presence of tumour‐infiltrating lymphocytes in the primary tumour and a lower propensity to have metastases in the SLN is well known …”

Section: Discussionmentioning

confidence: 99%

No association between smoking and sentinel lymph node metastasis and survival in cutaneous melanoma

Tejera‐Vaquerizo¹,

Descalzo²,

Traves

et al. 2019

Acad Dermatol Venereol

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Background There is little evidence that smoking is associated with metastasis in patients with cutaneous melanoma. Objective Using a propensity score matching analysis, we assessed whether smoking was associated with a higher rate of sentinel lymph node (SLN) metastasis and worse survival in these patients. Methods Retrospective cohort study at a referral hospital for melanoma. We studied 762 patients with known smoking status from the melanoma database of the Instituto Valenciano de Oncología who underwent SLN biopsy between 1 January 2000 and 31 December 2016. The patients were matched by smoking status. The matching procedure was implemented using three logistic regression models featuring never vs. former smokers, never vs. current smokers and former vs. current smokers. The study outcomes were disease‐free survival (DFS), melanoma‐specific survival (MSS), overall survival (OS) and SLN status. Results The following groups were formed based on the propensity matching scores: 114 pairs of smokers vs. never smokers, 113 pairs of smokers vs. former smokers and 174 pairs of never smokers vs. former smokers. Smoking status was not associated with SLN metastasis or with DFS, MSS or OS in any of the three groups. Conclusion Smoking does not influence SLN metastasis or survival in patients with cutaneous melanoma.

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Association of Histologic Regression in Primary Melanoma With Sentinel Lymph Node Status

Cited by 65 publications

References 33 publications

Regression in primary cutaneous melanoma: etiopathogenesis and clinical significance

Regression in primary cutaneous melanoma: etiopathogenesis and clinical significance

Multiple Lymph Node Basin Drainage in Trunk Melanoma Is Not Associated with Survival of Sentinel Lymph Node-Positive Patients

No association between smoking and sentinel lymph node metastasis and survival in cutaneous melanoma

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