Predictors of positive sentinel lymph node in thin melanoma

Yonick, David; Ballo, Rana M.; Kahn, Estelle; Dahiya, Madhu; Yao, Kathy; Godellas, Constantine V.; Shoup, Margo; Aranha, Gerard V.

doi:10.1016/j.amjsurg.2010.09.011

Cited by 54 publications

(34 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[6][7][8] Recent guidelines, 9,10 also noting the lack of evidence to support routine SNB in T1 patients, state that SNB should be considered for selected high-risk patients. These considerations highlight the variable risks associated with T1 melanomas and the need to identify characteristics for reliable risk stratification.…”

Section: Introductionmentioning

confidence: 99%

Prediction of Survival in Patients With Thin Melanoma: Results From a Multi-Institution Study

Maurichi

Miceli

Camerini

et al. 2014

JCO

106

116

View full text Add to dashboard Cite

A B S T R A C T PurposeCutaneous melanoma incidence is increasing. Most new cases are thin (Յ 1 mm) with favorable prognoses, but survival is nonetheless variable. Our aim was to investigate new prognostic factors and construct a nomogram for predicting survival in individual patients. Patients and MethodsData from 2,243 patients with thin melanoma were retrieved from prospectively maintained databases at six centers. Kaplan-Meier survival and crude cumulative incidences of recurrence were estimated, and competing risks were taken into account. Multivariable Cox regression was used to investigate survival predictors. ResultsMedian follow-up was 124 months (interquartile range, 106 to 157 months); 12-year overall survival was 85.3% (95% CI, 83.4% to 87.2%). Median times to local, regional, and distant recurrence were 79, 78, and 107 months, respectively. Relapse was significantly related to age, Breslow thickness, mitotic rate (MR), ulceration, lymphovascular invasion (LVI), and regression; incidence was lower and subgroup differences were less marked for distant metastasis than for regional relapse. The worst prognosis categories were age older than 60 years, Breslow thickness more than 0.75 mm, MR Ն 1, presence of ulceration, presence of LVI, and regression Ն 50%. Breslow thickness more than 0.75 mm, MR Ն 1, presence of ulceration, and LVI (all P ϭ .001) were significantly associated with sentinel node positivity. Age, MR, ulceration, LVI, regression, and sentinel node status were independent predictors of survival and were used to construct a nomogram to predict 12-year overall survival. The nomogram was well calibrated and had good discriminative ability (adjusted Harrell C statistic, 0.88). ConclusionOur findings suggest including LVI and regression as new prognostic factors in the melanoma staging system. The nomogram appears useful for risk stratification in clinical management and for recruiting patients to clinical trials.

show abstract

Section: Introductionmentioning

confidence: 99%

Prediction of Survival in Patients With Thin Melanoma: Results From a Multi-Institution Study

Maurichi

Miceli

Camerini

et al. 2014

JCO

106

116

View full text Add to dashboard Cite

show abstract

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Munsch

Lauwers‐Cancès

Lamant³

et al. 2014

Dermatology

View full text Add to dashboard Cite

Background: Sentinel lymph node biopsy (SLNB) is the most sensitive procedure for assessing nodal status in patients with primary melanoma. Objective: To evaluate the predictive ability of usual primary melanoma prognosis factors of detecting sentinel lymph node (SLN) metastasis in patients with melanoma. Patients and Methods: A cohort of 612 consecutive patients presenting with primary skin melanoma who underwent a SLNB was evaluated. Assessment of the determinants of SLN metastasis was based on general linear model analysis. The model performance was studied using the concordance statistic and the net reclassification index. The calibration was estimated using the Hosmer-Lemeshow test. Results: The discrimination ability did not differ significantly between Breslow thickness (0.57), Clark index (0.61), ulceration (0.57) and histological subtype (0.55). Clark index, ulceration and Breslow thickness were all significant and independent determinants of SLN metastasis. The predictive ability of the final model was 0.657. Conclusion: Breslow thickness, Clark index and ulceration are independent predictors of a SLN metastasis.

show abstract

“…[16][17][18][19] When regional nodes are involved, survival rates are roughly halved. However, within stage III, 5-year survival rates range from 20% to 70%, depending primarily on the nodal tumor burden.…”

mentioning

confidence: 99%

Melanoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology

Coit¹,

Thompson²,

Algazi³

et al. 2016

J Natl Compr Canc Netw

218

167

View full text Add to dashboard Cite

OverviewIn 2016, an estimated 76,380 patients will be diagnosed with and approximately 10,130 patients will die of melanoma in the United States.1 However, these figures for new cases may represent a substantial underestimate, as many superficial and in situ melanomas treated in the outpatient setting are not reported. The incidence of melanoma continues to increase dramatically, at an overall rate of 33% for men and 23% women from 2002 to 2006.2 Melanoma is increasing in men more rapidly than any other malignancy, and in women more rapidly than any other malignancy except lung cancer. AbstractThis selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Melanoma focuses on adjuvant therapy and treatment of in-transit disease, because substantial changes were made to the recommendations for the 2016 update. Depending on the stage of the disease, options for adjuvant therapy now include biochemotherapy and highdose ipilimumab. Treatment options for in-transit disease now include intralesional injection with talimogene laherparepvec (T-VEC), a new immunotherapy. These additions prompted reassessment of the data supporting older recommended treatment options for adjuvant therapy and in-transit disease, resulting in extensive revisions to the supporting discussion sections. J Natl Compr Canc Netw 2016;14(4):450-473 NCCN Categories of Evidence and ConsensusCategory 1: Based upon high-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2A: Based upon lower-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2B: Based upon lower-level evidence, there is NCCN consensus that the intervention is appropriate. Category 3: Based upon any level of evidence, there is major NCCN disagreement that the intervention is appropriate.All recommendations are category 2A unless otherwise noted.Clinical trials: NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Please NoteThe NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ® ) are a statement of consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult the NCCN Guidelines ® is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient's care or treatment. The National Comprehensive Cancer Network ® (NCCN ® ) makes no representation or warranties of any kind regarding their content, use, or application and disclaims any responsibility for their applications or use in any way. The full NCCN Guidelines for Melanoma are not printed in this issue of JNCCN but can be accessed online at NCCN.org.© National Comprehensive Cancer Network, Inc. 2016, All rights reserved. The NCCN Guidelines and the illustrations herein may not be reproduced in any form without the express written permission of NCCN. Disclosures for the NCCN Melanoma ...

show abstract

Predictors of positive sentinel lymph node in thin melanoma

Cited by 54 publications

References 10 publications

Prediction of Survival in Patients With Thin Melanoma: Results From a Multi-Institution Study

Prediction of Survival in Patients With Thin Melanoma: Results From a Multi-Institution Study

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

Melanoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology

Contact Info

Product

Resources

About