The Progression of Melanoma Nodal Metastasis Is Dependent on Tumor Thickness of the Primary Lesion

Haddad, F.; Stall, Alec; Messina, Jane L.; Brobeil, A; Ramnath, Eric; Glass, L. Frank; Cruse, C. Wayne; Berman, Claudia G.; Reintgen, Douglas S.

doi:10.1007/s10434-999-0144-y

Cited by 77 publications

(37 citation statements)

References 9 publications

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“…There is, however, some measure of disagreement in published reports on the predictive value of micrometer-measured thickness of the primary melanoma. Some studies report that thin primary melanomas are associated with a low incidence of tumor spread beyond the sentinel node, [21][22][23][24][25] while others have not reported this correlation. 26,27 The algorithmic approach that we present is practical and yields reliable information.…”

Section: Discussionmentioning

confidence: 99%

Prediction of metastatic melanoma in nonsentinel nodes and clinical outcome based on the primary melanoma and the sentinel node

et al. 2004

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Lymphatic mapping and sentinel node biopsy are well-established techniques for staging and managing patients with melanoma, breast cancer and other malignancies that spread initially to the regional lymph nodes. Identification of tumor in the sentinel node is the most precise staging technique currently available. The sentinel node is the site of metastatic melanoma in approximately 20% of melanoma patients and if tumor is present in the sentinel node it is customary to perform a complete dissection of the lymph nodes of the affected nodal basin. This may be overtreatment for some patients as tumor is identified in the nonsentinel nodes of only one-third of sentinel node-positive melanoma patients treated by completion lymphadenectomy. If it were possible accurately to identify the minority of patients with tumor in the nonsentinel nodes, the patients most likely to benefit from lymphadenectomy, the remaining patients could be spared a potentially morbid operation that is unlikely to confer clinical advantage. In 90 patients with a melanoma-positive sentinel node, who subsequently had a completion lymphadenectomy, we evaluated and compared the capacity of characteristics of the primary melanoma and of the sentinel node to predict individuals likely to have tumor in nonsentinel nodes. We assessed the Breslow thickness of the primary, the amount of tumor in the sentinel node (relative tumor area) and, as an index of immune modulation of the sentinel node, the density of dendritic leukocytes in the nodal paracortex. The relative area of tumor in the sentinel node and Breslow thickness of the primary melanoma most accurately predicted the presence of tumor in the nonsentinel nodes (P ¼ 0.0001 in both cases-Wilcoxon rank sums). The presence of melanoma in the nonsentinel nodes was also predicted by the density of dendritic leukocytes in the paracortex (P ¼ 0.008-Wilcoxon rank sums). These three observations assessed alone and in combination predict the presence of tumor in the nonsentinel nodes with high accuracy. The same characteristics also significantly correlated with tumor recurrence (tumor burden, P ¼ 0.0001, Breslow, P ¼ 0.0001 and dendritic cell density, P ¼ 0.0007) and death from melanoma (tumor burden, P ¼ 0.0001, Breslow, P ¼ 0.0001 and dendritic cell density, P ¼ 0. Keywords: melanoma; sentinel node; tumor burden; immune suppression; tumor recurrence; melanoma deathThe techniques of lymphatic mapping and sentinel node biopsy were developed to improve the management of patients with high-risk (thick and deep) primary melanoma with a high potential for metastases, but no clinical evidence of metastatic spread.

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Section: Discussionmentioning

confidence: 99%

Prediction of metastatic melanoma in nonsentinel nodes and clinical outcome based on the primary melanoma and the sentinel node

et al. 2004

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“…Previous studies have suggested that there may be some melanoma patients for whom CLND may not be necessary because nodal metastasis was never detected beyond the sentinel nodes [18][19][20]. We performed an analysis to determine, among patients with positive SLN, the frequency of nodal metastasis in the non-sentinel nodes (i.e., the nodes in the CLND specimen).…”

Section: Nodal Metastasis Beyond the Sentinel Nodesmentioning

confidence: 99%

Lessons learned from the Sunbelt Melanoma Trial

McMasters

Noyes

Reintgen

et al. 2004

Journal of Surgical Oncology

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107

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The Sunbelt Melanoma Trial is an ongoing multicenter prospective randomized trial that involves 79 centers and over 3600 patients from across the United States and Canada. This is one of the first large randomized studies to incorporate molecular staging using reverse transcriptase polymerase chain reaction (RT-PCR). While the results related to the primary endpoints of the study are not yet available, several analyses have shed light on many aspects of sentinel lymph node (SLN) biopsy and melanoma prognostic factors. In particular, we have developed a practical definition of sentinel nodes based on the degree of radioactivity. We have established the low rate of postoperative complications associated with SLN biopsy as compared to complete lymph node dissection. We have identified factors that predict the presence of SLN metastases. In contrast, we have been unable to identify factors that indicate a low risk of non-sentinel node metastases in patients with a positive sentinel node, suggesting that completion lymphadenectomy is appropriate for such patients. We have further established the value of identifying interval or in-transit sentinel nodes, which can be the only site of nodal metastasis. We have evaluated the particular challenges associated with SLN biopsy of head and neck melanomas, have evaluated the patterns of early recurrence, and have identified an interesting correlation between increasing patient age and a number of prognostic factors. Future analyses will evaluate the benefit of early therapeutic lymphadenectomy and early institution of adjuvant interferon alfa-2b therapy, as well as the validity of molecular staging.

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“…[6][7][8][9][10][11] There is ample evidence supportive of a strong correlation between the thickness of the PCM and the metastatic capacity of spreading either via the draining lymphatic channels or hematogenously. 12,13 Once melanoma has metastasized by either route, the overall survival for patients greatly diminishes.…”

Section: The Impact Of Genomics In Understanding Human Melanomamentioning

confidence: 99%

The Impact of Genomics in Understanding Human Melanoma Progression and Metastasis

et al. 2008

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Background: Recent technological advances in the analysis of the human genome have opened the door to improving our primitive understanding of the gene expression patterns in cancer. For the first time From the Basic and Translational Research Department (SR, SL, PH, YX, JJ, AIR) and Surgical Oncology Program (AIR) at the University of South Alabama Mitchell Cancer Institute, Mobile, Alabama; and the Microarray Core Facility at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida (SAE). Submitted October 9, 2007; accepted November 27, 2007

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The Progression of Melanoma Nodal Metastasis Is Dependent on Tumor Thickness of the Primary Lesion

Abstract: These results suggest that regional lymph node involvement may be dependent on the thickness of the primary tumor. As the primary tumor thickness increases, so does the likelihood of involvement of SLNs and higher regional nodes in the basin beyond the positive SLNs.

Cited by 77 publications

References 9 publications

Prediction of metastatic melanoma in nonsentinel nodes and clinical outcome based on the primary melanoma and the sentinel node

Prediction of metastatic melanoma in nonsentinel nodes and clinical outcome based on the primary melanoma and the sentinel node

Lessons learned from the Sunbelt Melanoma Trial

The Impact of Genomics in Understanding Human Melanoma Progression and Metastasis

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