The Challenge of Defining Guidelines for Sentinel Lymph Node Biopsy in Patients with Thin Primary Cutaneous Melanomas

Gershenwald, Jeffrey E.; Coit, Daniel G.; Sondak, Vernon K.; Thompson, John F.

doi:10.1245/s10434-012-2562-5

Cited by 35 publications

(26 citation statements)

References 16 publications

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“…Mitotic rate was an independent adverse predictor of survival and ultimately replaced Clark level to define T1b lesions [7, 13, 15]. MR ≥ 1/mm 2 and BT > 0.76 mm are worrisome histological parameters for micrometastasis in a subset of patients with thin melanomas; however, the criteria for selecting “high-risk” thin melanomas for SLNB continue to evolve [28–31]. …”

Section: Discussionmentioning

confidence: 99%

“…However, by multivariate analysis, only BT, gender, and age remained significant for thin lesions [43, 47]. Factors to be considered for SLNB in patients with thin melanomas among at least some melanoma experts include patients with BT ≥ 0.76, MR ≥ 1/mm 2 , primary tumor ulceration, “young” age, and superficially shaved lesions with positive deep margins which may underestimate the actual BT [28, 31, 34, 44, 47, 49, 51]. However, ultimately the selection of a subset of patients with thin melanomas for SLNB requires coordinated discussion between the patient and clinician.…”

Section: Discussionmentioning

confidence: 99%

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Impact of the 2009 (7th Edition) AJCC Melanoma Staging System in the Classification of Thin Cutaneous Melanomas

Chu

Tetzlaff

Torres‐Cabala

et al. 2013

BioMed Research International

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Context. The 7th (2009) edition of the AJCC melanoma staging system incorporates tumor (Breslow) thickness, MR, and ulceration in stratifying T1 primary melanomas. Compared to the prior 6th (2001) edition, MR has replaced CL for thin melanomas. Objective. We sought to identify and report differences of the classification of thin melanomas as well as outcome of SLNB in patients according to the 6th and 7th editions at our institution. Results. 106 patients were identified with thin melanomas verified by wide excision. 31 of 106 thin melanomas were reclassified according to the 7th edition of the AJCC. Of those 31, 15 CL II/III patients (6th edition T1a) were reclassified as T1b based on the presence of mitoses while 16 CL IV patients (6th edition T1b) were categorized as T1a based on the absence of mitoses. 26/31 reclassified patients underwent SLNB, and all were negative. Patients with thin melanoma and a +SLNB (N = 3) were all classified as T1b according to both staging systems. Conclusions. In our experience, 29% of thin melanomas were reclassified according to the 7th edition with similar proportions of patients re-distributed as T1a (14%) and T1b (15%). Cases with +SLN corresponded with T1b lesions in both 6th and 7th editions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of the 2009 (7th Edition) AJCC Melanoma Staging System in the Classification of Thin Cutaneous Melanomas

Chu

Tetzlaff

Torres‐Cabala

et al. 2013

BioMed Research International

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“…2 In addition, patients with cutaneous melanoma typically undergo sentinel lymph node biopsy for tumors greater than 1 mm in thickness or for tumors r1.0 mm when other adverse features are present: ulceration, dermal mitotic figures or a positive deep margin in the original biopsy specimen. [3][4][5] Thus, the presence of dermal mitotic figures in primary melanoma has emerged as a critical variable in subsequent management decisions and prognostic algorithms.…”

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confidence: 99%

Immunodetection of phosphohistone H3 as a surrogate of mitotic figure count and clinical outcome in cutaneous melanoma

et al. 2013

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In the American Joint Committee on Cancer (AJCC)-TNM (2009) staging system, the key prognostic factor in cutaneous melanoma is the depth of dermal invasion (Breslow thickness) with further refinement according to the presence of epidermal ulceration or dermal mitoses. Immunodetection of phosphohistone H3 has been shown to facilitate the identification of mitotic figures in various neoplasms. We selected 120 cases of primary cutaneous melanoma with completely annotated histopathologic parameters and clinical outcomes and performed double immunohistochemical staining for MLANA (Mart-1/Melan-A) and phosphohistone H3. One hundred and thirteen cases were amenable to antiphosphohistone H3 staining from 66 men and 47 women, with mean age of 64 years (9-93), including 61 superficial spreading type, 24 nodular, 6 lentigo maligna, 8 acral lentiginous, and 14 unclassified. The mean Breslow thickness was 2.53 mm (0.20-25), ulceration was present in 25/113 (22%) and the mean mitotic count was 3.2/mm 2 (o1-29/mm 2 ). In 27/113 (24%) of the cases, antiphosphohistone H3 failed to highlight mitotic figures anywhere in the tissue (normal or tumor cell), whereas in 86/113 (76%) antiphosphohistone H3 detected at least one mitotic figure. Among the latter, antiphosphohistone H3 did not detect mitotic figures in dermal tumor cells in 37/86 cases (43%), whereas anti-PHH3 identified at least one melanocytic mitotic figure in the other 49/86 cases (57%; range: 1-66/mm 2 ). The relationship between phosphohistone H3 and manual mitotic count was statistically significant (Pearson correlation ¼ 0.59, Po0.0001). Logistic regression analyses demonstrated an association between the development of subsequent metastatic disease and the following variables: mitotic figures (odds ratio (OR) ¼ 5.7; P ¼ 0.0001); phosphohistone H3-positive mitotic figures (OR ¼ 3.0; P ¼ 0.008); Breslow thickness (OR ¼ 4.0 per mm; P ¼ 0.0002); ulceration (OR ¼ 3.94; P ¼ 0.008). The application of phosphohistone H3 immunohistochemistry to the description of primary cutaneous melanoma is useful in identifying mitotic figures, improves upon the specificity of this designation when used together with MLANA, and correlates with an increased risk for metastasis in univariate analyses.

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“…As a consequence of the paucity of evidence in the field of melanoma follow-up, there is some variability in the recommendations provided [2]. Without clear definitions, the stringent evidence basis of the guidelines may fail to translate into clinical practice [3].…”

Section: Current Guidelinesmentioning

confidence: 99%

A review of sentinel lymph node biopsy for thin melanoma

et al. 2014

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The Challenge of Defining Guidelines for Sentinel Lymph Node Biopsy in Patients with Thin Primary Cutaneous Melanomas

Cited by 35 publications

References 16 publications

Impact of the 2009 (7th Edition) AJCC Melanoma Staging System in the Classification of Thin Cutaneous Melanomas

Impact of the 2009 (7th Edition) AJCC Melanoma Staging System in the Classification of Thin Cutaneous Melanomas

Immunodetection of phosphohistone H3 as a surrogate of mitotic figure count and clinical outcome in cutaneous melanoma

A review of sentinel lymph node biopsy for thin melanoma

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