The Prognostic Importance of Sentinel Lymph Node Biopsy in Thin Melanoma

Abstract

SLNB histology in melanomas < or = 1.0 mm deep is a significant predictor of outcome. SLNB should be considered for selected patients with melanomas .75 to 1.0 mm.

The Current Role of Sentinel Lymph Node Biopsy in Breast, Melanoma, and Gastrointestinal Cancers

“…19 Other clinicians have reported their institutional results for SLNB in this group, confirming a consistently low incidence of occult nodal metastasis and a variability of tumor/patient characteristics that correlated with nodal status. [20][21][22] We recently reported our own results for SLNB in a large group of thin melanoma patients and confirmed the important prognostic significance of SN status in this patient group, in terms of both recurrent disease and melanoma-specific survival. 23 Thick melanoma patients have traditionally not been offered surgical staging of the regional nodal basin because their high risk for occult distant metastases was felt to be prohibitive and also more indicative of outcome than nodal status.…”

Chinese Guidelines on the Diagnosis and Treatment of Melanoma (2015 Edition)

“…However, the SN-positive rate increased in melanoma patients with small thickness but with at least one risk factor (ulceration Clark level IV, nodular growth, high MR, recurrence, or aged ≤40 years) (62). In melanoma patients with tumor thickness of ≤1 mm, the relationship between positive SLNs and survival is still disputed (63)(64)(65)(66)(67).…”

“…In addition to tumor thickness, other factors such as Clark level (61,63,64,66), MR (64,68), ulceration (61,69), lymphatic vessel invasion (66), VGP (70,71), and TIL (72)(73)(74) can also be used to predict the positive SLNs in patients with thin melanoma. However, some data remain controversial, and whether they can be used for predicting tumor recurrence requires further verification (75)(76)(77).…”

Non-Invasive Determination of Breslow Index

“…National Comprehensive Cancer Network recommendations are to perform SLNB on appropriate patients defined as patients with stage IA thin melanomas (1.0 mm or less) with adverse prognostic factors such as thickness over 0.75 mm, positive deep margins, lymphovascular invasion, or young patient age. Ranieri et al (Ranieri, Wagner et al 2006) mention Breslow thickness, Clark level of invasion and mitotic index as statistically significant criterions in disease subset <1 mm in predicting the SLNB result. In the disease subset .75 to 1.0 mm thick, only mitotic index was predictive of the SLNB result.…”