SLN melanoma micrometastasis predictivity of nodal status: a long term retrospective study

Abstract

BackgroundCompletion lymph node dissection (CLND) is the gold standard treatment for patients with a positive sentinel lymph node (SLN) biopsy. Considering the morbidity associated with CLND it is important to identify histological features of the primary tumor and/or of SLN metastasis that could help to spare from CLND a subset of patients who have a very low risk of non-SLN metastasis. The objective of this study is to identify patients with a very low risk to develop non-SLNs recurrences and to limit unnecessary CLND.MethodsA retrospective long-term study of 80 melanoma patients with positive SLN, undergone CLND, was assessed to define the risk of additional metastasis in the regional nodal basin, on the basis of intranodal distribution of metastatic cells, using the micro-morphometric analysis (Starz classification).ResultsThis study demonstrates that among the demographic and pathologic features of primary melanoma and of SLN only the Starz classification shows prognostic significance for non-SLN status (p<0.0001). This parameter was also significantly associated with disease-free survival rate (p<0.0013).ConclusionThe Starz classification can help to identify, among SLN positive patients, those who can have a real benefit from CLND. From the clinical point of view this easy and reliable method could lead to a significant reduction of unnecessary CLND in association with a substantial decrease in morbidity. The study results indicate that most of S1 subgroup patients might be safely spared from completion lymphatic node dissection. Furthermore, our experience demonstrated that Starz classification of SLN is a safe predictive index for patient stratification and treatment planning.

Utility of sentinel lymph node biopsy for solitary dermal melanomas

“…These factors are intuitively relevant. The pathologic assessment of sentinel nodes is not widely standardized , and the clinical relevancy of micrometastates in sentinel nodes has recently come under focused attention . If a large proportion of SNBx's yield positive nodes—i.e., increased sensitivity for micrometastases—a larger portion of patients may be subjected to CLND procedures which may not offer meaningful therapeutic benefit.…”

Sentinel lymph node biopsies in patients with malignant melanoma — qualifying principles and histopathological assessment (2017)

“…They are less frequently found in the lymph node parenchyma, in the fibrous capsule or in perinodal tissues (less than 5% cases). Melanoma metastases are found in about 20% of sentinel lymph nodes [24]. In 16% cases, they can be already detected by routine staining with haematoxylin and eosin, whilst in 4% they require detection and confirmation by immunohistochemical tests [24].…”

“…Melanoma metastases are found in about 20% of sentinel lymph nodes [24]. In 16% cases, they can be already detected by routine staining with haematoxylin and eosin, whilst in 4% they require detection and confirmation by immunohistochemical tests [24]. Out of the recommended tests of melanoma markers S100, HMB-45 ( Fig.…”