Tumour regression predicts higher risk of sentinel node involvement in thin cutaneous melanomas

Oláh, Judit; Gyulai, Rolland; Korom, Irma; Varga, Erika; Dobozy, A.

doi:10.1046/j.1365-2133.2003.05502.x

Cited by 67 publications

(46 citation statements)

References 10 publications

(10 reference statements)

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“…2,4,[81][82][83][84][85][86][87][88][89][90][91][92][93][94][95][96][97][98][99] In contrast, other studies have indicated that the presence of regression in melanoma was associated with a poor prognosis (Table 2). 7,72,[74][75][76]78,[100][101][102][103] On the other hand, additional studies have suggested that regression indicates a favorable outcome (Table 3). 3,[104][105][106][107][108] Thus, the prognostic significance of regression in primary melanoma has been controversial for many years.…”

Section: Prognostic Significance Of Regression In Melanomamentioning

confidence: 99%

“…74,78,100,103 Others have examined the stage and extent of regression and reported increased incidence of metastasis in melanomas with regression. 4,7,76,78,110 In their large study of cutaneous stage I and stage II melanomas, Shaw et al 109 reported that regression was present in all 28 cases of thin melanoma (Breslow thickness o0.76 mm) that presented with concurrent regional lymph node metastases (stage II), suggesting an association between regression and lymph node metastasis.…”

Section: Association Between Regression and Recurrencementioning

confidence: 99%

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Regression in primary cutaneous melanoma: etiopathogenesis and clinical significance

Aung

Nagarajan

Prieto

2017

Laboratory Investigation

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Though not required currently for staging, regression is a histopathologic parameter typically reported upon diagnosis of an invasive primary cutaneous melanoma. The studies examining the prognostic significance of regression in patient outcome have yielded controversial findings; likely because the definition and assessment of regression have not been consistent, in addition to subjectivity of pathologists' interpretation. Regression is histologically characterized by variable decrease in the number of melanoma cells accompanied by the presence of a host response consisting of dermal fibrosis, inflammatory infiltrate, melanophages, ectatic blood vessels, epidermal attenuation, and/or apoptosis of keratinocytes or melanocytes; the relative extent of these features depends on the stage of the regression. However, the magnitudes to which these individual changes must be present to meet the threshold of histologic regression have not been well defined or agreed upon, and thus, the definition and classification of histologic regression in melanoma varies considerably among institutions and even among individual pathologists. In order to determine the clinical significance of histologic analysis of regression, there is a compelling need for a universal scheme to objectively define and assess histologic regression in primary cutaneous melanoma, so that the biologic and prognostic significance of this process may be completely understood.

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Section: Prognostic Significance Of Regression In Melanomamentioning

confidence: 99%

Section: Association Between Regression and Recurrencementioning

confidence: 99%

Regression in primary cutaneous melanoma: etiopathogenesis and clinical significance

Aung

Nagarajan

Prieto

2017

Laboratory Investigation

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“…Clearly, a very selective approach is warranted in this group, which should be directed by an accurate risk assessment for the incidence of SLN metastases. Higher-risk subsets have been identified by the presence of regression in the primary tumor (38) or the presence of vertical growth phase (39). Prognostic modeling as described above has been used to help better define a high-risk cohort.…”

Section: Sentinel Node Stagingmentioning

confidence: 99%

Early-Stage Melanoma: Staging Criteria and Prognostic Modeling

Ross¹

2006

Clinical Cancer Research

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Accurate risk assessment is central to the process of making rational surgical and systemic treatment recommendations for melanoma patients and in establishing appropriate clinical trial stratification criteria. The current American Joint Commission on Cancer melanoma staging system incorporated relevant prognostic variables to provide a framework for the estimation of risk for recurrence; however, significant prognostic heterogeneity exists within the stage groupings. In the stage I/II group, survival rates range from 40% to 95% as defined by the combination of tumor thickness and ulceration. The use of novel prognostic factors, such as mitotic rate, sentinel node biopsy, and prognostic modeling using a variety of factors, can minimize this prognostic heterogeneity and provide a more accurate and individualized prognostic profile. Recent modifications in the stage III criteria include the number of positive nodes, whether the nodal disease is microscopic or clinically apparent, and the presence of an ulcerated primary. Through these factors, survival estimates can be provided, but like the stage I/II group, wide ranges in prognosis exist. The complexion of the stage III population is in evolution as a result of increasing numbers of patients being diagnosed as having microscopic sentinel node disease. Contemporary efforts are focused on defining the prognosis and natural history of this group.Through prognostic modeling using the number of nodes involved, ulceration status, and a measure of disease burdenödisease in the sentinel nodeörelatively homogeneous subgroups can be identified. Long-term follow-up of patients staged with PCR molecular techniques on sentinel nodes shows conflicting value in assessing prognosis and therefore cannot be routinely used outside a clinical trial. The combination of genomic profiling using microarray analyses and the development of targeted therapy holds the future promise of individualizing prognosis and therapy.

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“…Several studies have been conducted to identify predictors of SLN metastasis based on clinical and pathological analysis of the primary melanoma. Elevated Clark index [10,11,12,13,14], high mitotic rate [12,15,16,17,18], ulceration of the primary melanoma [19,20], regression [21,22], vascular invasion [23], vertical growth phase [24,25] and Breslow thickness >0.75 mm [19] have been reported to be associated with SLN metastasis. However most of the studies had a short follow-up (<5 years) and were conducted on a limited number of patients [7,8,26].…”

Section: Introductionmentioning

confidence: 99%

Breslow Thickness, Clark Index and Ulceration Are Associated with Sentinel Lymph Node Metastasis in Melanoma Patients: A Cohort Analysis of 612 Patients

Munsch

Lauwers‐Cancès

Lamant³

et al. 2014

Dermatology

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Background: Sentinel lymph node biopsy (SLNB) is the most sensitive procedure for assessing nodal status in patients with primary melanoma. Objective: To evaluate the predictive ability of usual primary melanoma prognosis factors of detecting sentinel lymph node (SLN) metastasis in patients with melanoma. Patients and Methods: A cohort of 612 consecutive patients presenting with primary skin melanoma who underwent a SLNB was evaluated. Assessment of the determinants of SLN metastasis was based on general linear model analysis. The model performance was studied using the concordance statistic and the net reclassification index. The calibration was estimated using the Hosmer-Lemeshow test. Results: The discrimination ability did not differ significantly between Breslow thickness (0.57), Clark index (0.61), ulceration (0.57) and histological subtype (0.55). Clark index, ulceration and Breslow thickness were all significant and independent determinants of SLN metastasis. The predictive ability of the final model was 0.657. Conclusion: Breslow thickness, Clark index and ulceration are independent predictors of a SLN metastasis.

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Tumour regression predicts higher risk of sentinel node involvement in thin cutaneous melanomas

Cited by 67 publications

References 10 publications

Regression in primary cutaneous melanoma: etiopathogenesis and clinical significance

Regression in primary cutaneous melanoma: etiopathogenesis and clinical significance

Early-Stage Melanoma: Staging Criteria and Prognostic Modeling

Breslow Thickness, Clark Index and Ulceration Are Associated with Sentinel Lymph Node Metastasis in Melanoma Patients: A Cohort Analysis of 612 Patients

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