Mitotic Rate as a Predictor of Sentinel Lymph NodePositivity in Patients With Thin Melanomas

Abstract

In patients with thin melanomas, MR >0 seems to be a significant predictor of SLN positivity that may be used to risk-stratify and select patients for LM/SL. To confirm these results, the predictive value of MR for SLN positivity needs to be validated in other populations of thin-melanoma patients.

Breslow Thickness, Clark Index and Ulceration Are Associated with Sentinel Lymph Node Metastasis in Melanoma Patients: A Cohort Analysis of 612 Patients

“…A large number of studies have tried to identify the criteria that may be used to indicate SLNB in thin melanomas, with conflicting results. Most of them were conducted on short retrospective heterogeneous cohorts [11,18,20,40,41]. In our study, we were not able to identify criteria associated with SLN metastasis in the subpopulation of patients with melanoma <1 mm.…”

“…The present AJCC staging classification recommends the use of mitotic rate as a prognostic factor (T1a vs. T1b). It has previously been reported that the risk of SLN metastasis is increased in case of a mitotic index >1 [18,20,39]. This may have influenced our results.…”

“…Several studies have been conducted to identify predictors of SLN metastasis based on clinical and pathological analysis of the primary melanoma. Elevated Clark index [10,11,12,13,14], high mitotic rate [12,15,16,17,18], ulceration of the primary melanoma [19,20], regression [21,22], vascular invasion [23], vertical growth phase [24,25] and Breslow thickness >0.75 mm [19] have been reported to be associated with SLN metastasis. However most of the studies had a short follow-up (<5 years) and were conducted on a limited number of patients [7,8,26].…”

The Role of Sentinel Lymph Node Biopsy in Thin Melanoma (Breslow Thickness ≤ 0.75 mm and 0.76 mm - 1.0 mm Respectively): Our Results and Review of the Literature

“…The guidelines in regard to Breslow thickness, taking in mind where SLNB staging benefits do not outweigh the risks of the procedure, are constantly reviewed and modified. Factors associated with increased incidence of positive SLNs in melanoma patients have been thoroughly studied and reported in the literature and include tumor thickness [5]- [24], ulceration [16]- [22], mitotic rate [7] [14] reported positive SLN in the ≤0.75 mm group (group A), ranging from 1.7% to 6% (Table 4). In our study (Table 1) in the 0.76 -1.00 mm group (group B) the percentage of positive SLNs was 11.1%, whereas in the above-mentioned studies [5]- [14] it was ranging from 3.9% to 12.8%.…”

A review of sentinel lymph node biopsy for thin melanoma

“…The variation of selection criteria among published retrospective studies with small patient populations makes comparisons difficult [4][5][6][7]. Factors reported to be predictive of SLN positivity include Breslow thickness, ulceration, mitotic rate, Clark level, lymphovascular invasion, age, melanoma subtype, and tumor location [8][9][10][11][12][13][14]. Some studies have identified no predictive parameters [15][16][17][18].…”