Prediction of Sentinel Node Status and Clinical Outcome in a Melanoma Centre

Abstract

Background. Sentinel lymph node biopsy (SLNB) is a standard procedure for patients with localized cutaneous melanoma. The National Comprehensive Cancer Network (NCCN) Melanoma Panel has reinforced the status of the sentinel lymph node (SLN) as an important prognostic factor for melanoma survival. We sought to identify predictive factors associated with a positive SLNB and overall survival in our population. Methods. We performed a retrospective chart review of 221 patients who have done a successful SLNB for melanoma between 2004 and 2010 at our department. Univariate and multivariate analyses were done. Results. The SLNB was positive in 48 patients (21.7%). Univariate analysis showed that male gender, increasing Breslow thickness, tumor type, and absence of tumor-infiltrating lymphocytes were significantly associated with a positive SLNB. Multivariate analysis confirmed that Breslow thickness and the absence of tumor-infiltrating lymphocytes are independently predictive of SLN metastasis. The 5-year survival rates were 53.1% for SLN positive patients and 88.2% for SLN negative patients. Breslow thickness and the SLN status independently predict overall survival. Conclusions. The risk factors for a positive SLNB are consistent with those found in the previous literature. In addition, the SLN status is a major determinant of survival, which highlights its importance in melanoma management.

Treatment Outcome and Prognostic Factors for Malignant Skin Melanoma Treated with Radical Surgery

“…Because the predominant cause of treatment failure is distant metastases, the research should focus on a systemic adjuvant treatment. Our own results on that issue are in accordance with the results obtained by other authors, who have indicated that the presence of metastatic nodes is a strong unfavorable prognostic factor (Callery et al, 1982;Barnhill et al, 1996;White et al, 2002;Scaggins et al, 2010;Mervic, 2012;Teixeira et al, 2013;Deshmane et al, 2014). We were not able to reveal any detailed features that characterize nodal metastases and are potentially related to prognosis (e.g., node size, extracapsular extension, ratio of number of metastatic to resected nodes).…”

“…Wojciech Majewski 1 *, Karolina Stanienda 2 , Katarzyna Wicherska 2 , Rafal Ulczok 3 , Jerzy Wydmanski 1 local lymph nodes at the time of initial diagnosis (White et al, 2002;Scaggins et al, 2010;Mervic L, 2012;Teixeira et al, 2013;Deshmane et al, 2014) Because the clinical course of malignant melanoma is difficult to predict, it seems important to evaluate the clinical factors that may influence the prognosis. Such an assessment on a local population is recommended because the death rates due to malignant skin melanoma among Poles are significantly (up to 20%) higher than the average for the European Union (Wojciechowska and Didkowska, 2015).…”

When is a sentinel node biopsy indicated for patients with primary melanoma? An update of the ‘Australian guidelines for the management of cutaneous melanoma’

“…The 10‐year melanoma‐specific survival (MSS) for SLN‐positive patients was 62%, versus 85% for SLN‐negative patients (level of evidence III). Many large retrospective studies have also demonstrated the pre‐eminence of an SLNB in risk stratification, with all but one showing the status of the SLN to be the most significant predictor of MSS (HR 1.5–6.9) …”

Essential Components of Melanoma Histopathological Reporting: The Surgical Oncologist’s Perspective

“…Breslow thickness is also an independent predictor of sentinel lymph node (SLN) status [ 6 ]. In a retrospective review of 221 patients undergoing sentinel node biopsy, there is SLN positive rate of 4.8% in T1 patients, 11.2% in T2 patients, 28.1% in T3 patients, and 46.5% in T4 patients [ 6 ].…”

“…Breslow thickness is also an independent predictor of sentinel lymph node (SLN) status [ 6 ]. In a retrospective review of 221 patients undergoing sentinel node biopsy, there is SLN positive rate of 4.8% in T1 patients, 11.2% in T2 patients, 28.1% in T3 patients, and 46.5% in T4 patients [ 6 ]. Further data supports performing sentinel node biopsy (SNB) for microscopic staging of the regional lymph node basin when tumour thickness meets or exceeds 1 mm, or greater than or equal to 0.75 mm with other high risk features such as ulceration and/or high mitotic activity [ 7 ].…”