Lymph node metastasis in melanoma: a debate on the significance of nodal metastases, conditional survival analysis and clinical trials

Faries, Mark B.; Han, Dale; Reintgen, Michael; Kerivan, Lauren; Reintgen, Douglas S.; Caracò, Corrado

doi:10.1007/s10585-018-9898-6

Cited by 19 publications

(13 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…At present, performing a SLNB is mostly advised because of the impact on further adjuvant systemic (immune)therapy or trial participation. Moreover, the present data indicate that performing a SLNB in these patients has also some therapeutic effect, supporting in some way the incubator hypothesis [7].…”

Section: Discussionsupporting

confidence: 88%

See 1 more Smart Citation

Survival of sentinel node biopsy versus observation in intermediate-thickness melanoma: A Dutch population-based study

et al. 2021

View full text Add to dashboard Cite

Background The Multicenter Selective Lymphadenectomy Trial (MSLT-1) comparing survival after a sentinel lymph node biopsy (SLNB) versus nodal observation in melanoma patients did not show a significant benefit favoring SLNB. However, in subgroup analyses melanoma-specific survival among patients with nodal metastases seemed better. Aim To evaluate the association of performing a SLNB with overall survival in intermediate thickness melanoma patients in a Dutch population-based daily clinical setting. Methods Survival, excess mortality adjusted for age, gender, Breslow-thickness, ulceration, histological subtype, location, co-morbidity and socioeconomic status were calculated in a population of 1,989 patients diagnosed with malignant cutaneous melanoma (1.2–3.5 mm) on the trunk or limb between 2000–2016 in ten hospitals in the South East area, The Netherlands. Results A SLNB was performed in 51% of the patients (n = 1008). Ten-year overall survival after SLNB was 75% (95%CI, 71%-78%) compared to 61% (95%CI 57%-64%) following observation. After adjustment for risk factors, a lower risk on death (HR = 0.80, 95%CI 0.66–0.96) was found after SLNB compared to observation only. Conclusions SLNB in patients with intermediate-thickness melanoma on trunk or limb resulted in a 14% absolute and significant 10-year survival difference compared to those without SLNB.

show abstract

Section: Discussionsupporting

confidence: 88%

“…The discussion on this matter can be summarized as between two hypothesis camps: those who consider lymph nodes to be incubators for sequential “orderly progression” of the disease and those who consider this only as marker or indicator of the melanoma’s metastatic potential [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Survival of sentinel node biopsy versus observation in intermediate-thickness melanoma: A Dutch population-based study

et al. 2021

View full text Add to dashboard Cite

show abstract

“…SLNB has important prognostic value in cutaneous melanoma . The Multicenter Selective Lymphadenectomy Trial (MSLT)‐I demonstrated that SLN status is an important predictor for recurrence and death from melanoma in intermediate‐thickness cases (1‐4 mm) .…”

Section: Discussionmentioning

confidence: 99%

“…SLNB has important prognostic value in cutaneous melanoma. [8][9][10][11] The Multicenter Selective Lymphadenectomy Trial (MSLT)-I demonstrated that SLN status is an important predictor for recurrence and Additional studies have concluded that SLN status is also prognostic in cases of thick ( > 4 mm) melanoma. [13][14][15][16][17] This is of particular importance in ALM, in which patients typically have a delayed presentation with thicker melanomas, and a quarter of all nodal-staged patients with ALM will have a positive SLN.…”

Section: Discussionmentioning

confidence: 99%

Does sentinel lymph node status have prognostic significance in patients with acral lentiginous melanoma?

Pavri

Han

Khan

et al. 2019

Journal of Surgical Oncology

Self Cite

View full text Add to dashboard Cite

Background The prognostic benefit of sentinel lymph node biopsy (SLNB) and factors predictive of survival specifically in patients with acral lentiginous melanoma (ALM) are unknown. Methods The SEER database was queried for ALM cases that underwent SLNB from 1998 to 2013. Clinicopathological factors were correlated with SLN status, overall survival (OS), and melanoma‐specific survival (MSS). Results Median age for the 753 ALM study patients was 65 years, and 48.2% were male. Median thickness was 2 mm with 38.1% of cases having ulceration. SLN metastases were detected in 194 of 753 cases (25.7%). Multivariable analysis showed that thickness, Clark level IV‐V, and ulceration significantly predicted for SLN metastasis (P < 0.05). For patients with positive SLN, 5‐year OS and MSS were significantly worse at 48.1% and 58.9%, respectively, compared with 78.7% and 88.5%, respectively, for patients with negative SLN (P < 0.0001). On multivariable analyses, older age, male gender, increasing thickness, ulceration, and a positive SLN significantly predicted for worse OS and MSS (all P < 0.05). Conclusion This study confirms the important role of SLNB in ALM. SLN metastases are seen in 25.7% of ALM cases, providing significant prognostic information. In addition, thickness, ulceration status, and SLNB status significantly predict survival in patients with ALM.

show abstract

“…Although the true value of completion lymph node dissection in patients with positive SLN remains controversial, the accurate staging of lymph nodes is an important prognostic factor for patients with melanoma . Moreover, not all melanocytic cells found within a draining lymph node basin indicate aggressive biologic behavior, and nodal nevus could be mistaken for metastatic melanoma.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic utility of dual 5‐hydroxymethylcytosine/Melan‐A immunohistochemistry in differentiating nodal nevus from metastatic melanoma: An effective first‐line test for the workup of sentinel lymph node specimen

et al. 2019

View full text Add to dashboard Cite

Background Distinguishing benign nodal nevus from metastatic melanoma can be diagnostically challenging, with important clinical consequences. Recently, the loss of epigenetic marker, 5‐hydroxymethylcytosine (5‐hmC) expression by immunohistochemistry has been found in melanomas and atypical melanocytic neoplasms. Methods About 41 metastatic melanomas and 20 nodal nevi were retrieved. Nuclear 5‐hmC (brown) and cytoplasmic Melan‐A Red (red) double immunohistochemical staining was performed. Results Total or partial loss of nuclear expression of 5‐hmC was noted in 40/41 metastatic melanomas; these tumor cells were strongly positive for Melan‐A Red, except in one case of desmoplastic melanoma. All cases of nodal nevus showed uniformly retained nuclear expression of 5‐hmC accompanied by strong Melan‐A Red cytoplasmic staining. In two cases containing both nodal nevus and metastatic melanoma, all tumor cells were positive for Melan‐A Red, but a nuclear expression of 5‐hmC was selectively absent only in the melanoma tumor cells. Conclusion Dual 5‐hmC/Melan‐A Red immunohistochemistry is highly specific in distinguishing nodal nevus from metastatic melanoma. Our protocol for brown and red chromogens used in this study provides excellent color contrast and is easy to interpret. Furthermore, this dual staining method allows the preservation of limited tumor tissue, which could be used for potential molecular studies.

show abstract

Lymph node metastasis in melanoma: a debate on the significance of nodal metastases, conditional survival analysis and clinical trials

Cited by 19 publications

References 39 publications

Survival of sentinel node biopsy versus observation in intermediate-thickness melanoma: A Dutch population-based study

Survival of sentinel node biopsy versus observation in intermediate-thickness melanoma: A Dutch population-based study

Does sentinel lymph node status have prognostic significance in patients with acral lentiginous melanoma?

Diagnostic utility of dual 5‐hydroxymethylcytosine/Melan‐A immunohistochemistry in differentiating nodal nevus from metastatic melanoma: An effective first‐line test for the workup of sentinel lymph node specimen

Contact Info

Product

Resources

About