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NEW APPROACHES TO THE TREATMENT OF HEPATIC MALIGNANCIES |
From Winship Cancer Institute (GWC, DRM, CAS, AH, CC), Emory University School of Medicine; and Department of Biostatistics (RHL), Rollins School of Public Health, Emory University, Atlanta, Georgia.
Correspondence: Address correspondence and reprint requests to: Grant W. Carlson, MD, Winship Clinic, 1365B Clifton Road, Atlanta, GA 30322; Fax: 404-778-4255; E-mail: grant_carlson{at}emory.org
ABSTRACT
Background: The amount of metastatic disease in the sentinel lymph node (SLN) is examined as a prognostic factor in malignant melanoma.
Methods: SLN mapping was performed on 592 patients with stage I and II malignant melanoma from March 1, 1994, through December 31, 1999. One hundred four patients were found to have 134 sentinel SLNs containing metastatic melanoma. The slides were reviewed, and the size of the metastatic melanoma in each SLN was measured. The size of the metastatic deposit was defined as macrometastasis (>2 mm), micrometastasis (
2 mm), a cluster of cells (10–30 grouped cells) in the subcapsular space or interfollicular zone, or isolated melanoma cells (1 to 
20 individual cells) in subcapsular sinuses.
Results: The number of metastases in each SLN was isolated melanoma cells, n = 5 (3.7%); cluster of cells, n = 35 (26.1%); 2 mm, n = 45 (33.6%); and >2 mm, n = 49 (36.7%). Seventy-nine patients (76%) had a single positive SLN. The size of the largest nodal metastasis was used to stratify patients with multiple positive SLNs. The overall 3-year survival for patients with SLN micrometastases was 90%, versus 58% for patients with SLN macrometastases (P = .004).
Conclusions: The amount of metastatic melanoma in an SLN is an independent predictor of survival. Patients with SLN metastatic deposits >2 mm in diameter have significantly decreased survival.
Key Words: Sentinel lymph node • Melanoma • Metastatic disease • Prognosis
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