Stratifying SLN incidence in intermediate thickness melanoma patients

Chang, James M.; Kosiorek, Heidi E.; Dueck, Amylou C.; Leong, Stanley P. L.; Vetto, John T.; White, Richard L.; Avisar, Eli; Sondak, Vernon K.; Messina, Jane L.; Zager, Jonathan S.; Garberoglio, Carlos A.; Kashani‐Sabet, Mohammed; Pockaj, Barbara A.

doi:10.1016/j.amjsurg.2017.12.009

Cited by 26 publications

(20 citation statements)

References 34 publications

(42 reference statements)

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“…Our study, which mainly involved patients with thin to intermediate thickness cutaneous melanoma reached an SLN positivity rate (12.1%), which is similar to previous cohorts [26,45], and highlights the potential usefulness of sPD-L1 levels in patients with cutaneous melanoma and OSA. Regarding classic risk factors, our findings are consistent with those previously established in the literature.…”

Section: Discussionsupporting

confidence: 89%

“…However, the Breslow index is traditionally considered the most important predictor of SLN metastasis. In fact, in an analysis of 3460 patients with melanoma, multivariate analysis revealed young age and Breslow thickness as the only significant predictors, while mitotic rate and presence of ulceration were not retained in the model [45]. Although several studies found that ulceration or mitotic rate are associated with SLN metastasis [26,43,[46][47][48], their role as independent predictors of SLN involvement has not been consistently established.…”

Section: Discussionmentioning

confidence: 99%

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Soluble PD-L1 is a potential biomarker of cutaneous melanoma aggressiveness and metastasis in obstructive sleep apnoea patients

et al. 2019

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Obstructive sleep apnoea (OSA) upregulates the programmed cell death-1 receptor and its ligand (PD-L1) pathway, potentially compromising immunosurveillance. We compared circulating levels of soluble PD-L1 (sPD-L1) in patients with cutaneous melanoma according to the presence and severity of OSA, and evaluated relationships with tumour aggressiveness and invasiveness.In a multicentre observational study, 360 patients with cutaneous melanoma underwent sleep studies, and serum sPD-L1 levels were assayed using ELISA. Cutaneous melanoma aggressiveness indices included mitotic rate, Breslow index, tumour ulceration, Clark level and tumour stage, and sentinel lymph node (SLN) metastasis was recorded as a marker of invasiveness.sPD-L1 levels were higher in severe OSA compared to mild OSA or non-OSA patients. In OSA patients, sPD-L1 levels correlated with Breslow index and were higher in patients with tumour ulceration, advanced primary tumour stages or with locoregional disease. The incorporation of sPD-L1 to the classic risk factors to SLN metastasis led to net improvements in the classification of 27.3%.Thus, sPD-L1 levels are increased in melanoma patients with severe OSA, and, in addition, might serve as a potential biomarker of cutaneous melanoma aggressiveness and invasiveness in this group of subjects.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Soluble PD-L1 is a potential biomarker of cutaneous melanoma aggressiveness and metastasis in obstructive sleep apnoea patients

et al. 2019

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“…This rate of positive findings was lower than that in the subgroup of eyelid melanomas (20 patients), where 30% of sampled SLNs were positive. Similar rates have been found in cutaneous melanoma SLNBs 32. However, there were also two (7%) cases of false negative SLNB results in the CM cohort with patients developing late tumor recurrence in the regional lymph nodes.…”

Section: Published Resultssupporting

confidence: 81%

<p>Sentinel lymph node biopsy in the management of conjunctival melanoma: current insights</p>

Mor¹,

Rokohl²,

Koch³

et al. 2019

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Purpose: To evaluate the role of sentinel lymph node biopsy (SLNB) in conjunctival melanoma (CM). Methods: This article provides a review of the literature from PUBMED. Results: Data on SLNB in the management of CM are scarce and only two relatively large cohorts have been reported. Although indication criteria for SLNB vary slightly, positive findings can be expected in 11%–13% of CM cases, including small tumors. False negative SLNB findings are rare (<10%). Failure to identify SLNB has been attributed to the surgical learning curve and recurrent tumors with scar tissue impeding spread of the tracer material. Reported 5-year survival rate following CM management including SLNB, is up to 79%, but there are no comparative cohort studies proving the assumed benefit. Adverse events reported were non-severe and transient. Conclusion: Patients can potentially benefit from SLNB and the procedure can be offered to eligible patients. However, there is not enough evidence to support SLNB as a mandatory part of CM management.

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“…Predictors of sentinel LN status have been extensively studied, identifying younger age, increasing thickness, ulceration, lymphovascular invasion, and mitotic rate to be associated with nodal positivity. [13][14][15][16][17] To the authors' best knowledge, no studies have specifically evaluated characteristics associated with the extent of pathologic nodal burden in patients with cLN metastases. Using multivariable logistic regression, preoperative imaging was identified to be strongly associated with pathologic outcome.…”

Section: Discussionmentioning

confidence: 99%

Characteristics Associated with Pathologic Nodal Burden in Patients Presenting with Clinical Melanoma Nodal Metastasis

et al. 2019

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Background-Nodal observation is safe for patients with microscopic melanoma metastasis in a sentinel lymph node (LN). Complete LN dissection (CLND) remains the standard of care for patients with clinically evident LN (cLN) metastases, even though about 40% have only one pathologic LN (pLN). We sought to identify clinical features associated with having one pLN among patients with cLNs. Methods-Patients at three melanoma centers who underwent CLND for cLNs were identified. Clinicopathologic and imaging characteristics associated with one pLN were determined by multivariable logistic regression and classification tree analysis. Results-Of 190 patients, 90 (47.4%) had one pLN and 100 (52.6%) had more than one pLN. By multivariable logistic regression, extremity versus truncal primary (odds ratio [OR] 2.15, p = 0.012), axillary versus superficial inguinal location (OR 3.89, p = 0.009), and preoperative crosssectional imaging demonstrating more than one versus one cLN (OR 17.1, p < 0.001) were associated with more than one pLN. The negative predictive value for additional pathologic nodal disease of preoperative imaging was 70.9%, increasing to 74.4% for positron emission tomography/computed tomography. In the subgroup of patients with one cLN, the classification tree identified two groups with < 10% risk of additional pLNs: (1) Breslow thickness > 6.55 mm

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Stratifying SLN incidence in intermediate thickness melanoma patients

Cited by 26 publications

References 34 publications

Soluble PD-L1 is a potential biomarker of cutaneous melanoma aggressiveness and metastasis in obstructive sleep apnoea patients

Soluble PD-L1 is a potential biomarker of cutaneous melanoma aggressiveness and metastasis in obstructive sleep apnoea patients

<p>Sentinel lymph node biopsy in the management of conjunctival melanoma: current insights</p>

Characteristics Associated with Pathologic Nodal Burden in Patients Presenting with Clinical Melanoma Nodal Metastasis

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