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Originally published as Ann Surg Oncol Early Release 10.1245/ASO.2004.10.002 on September 20, 2004

Annals of Surgical Oncology 11:900-906 (2004)
© 2004 Society of Surgical Oncology
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Article

Indications for Lymphatic Mapping and Sentinel Lymphadenectomy in Patients with Thin Melanoma (Breslow Thickness ≤1.0 mm)

Karyn B. Stitzenberg, MD, Pamela A. Groben, MD, Stacey L. Stern, MS, Nancy E. Thomas, MD, Thomas A. Hensing, MD, Leah B. Sansbury, MSPH and David W. Ollila, MD

From the Department of Surgery (KBS, DWO), Department of Pathology (PAG), Department of Dermatology (NET), and Division of Surgical Oncology (DWO), School of Medicine; the Cecil G. Sheps Center for Health Services Research (KBS); and the Department of Epidemiology, School of Public Health (LBS), University of North Carolina, Chapel Hill, North Carolina; CancerVax Corporation (SLS), Carlsbad, California; and Department of Medicine (TAH), Evanston Northwestern Healthcare, Evanston, Illinois

ABSTRACT

Background: Patients with thin (Breslow thickness ≤1.0 mm) melanoma have a good prognosis (5-year survival >90%). Consequently, the added benefit of lymphatic mapping and sentinel lymphadenectomy (LM/SL) in these patients is controversial. We hypothesize that LM/SL with a focused examination of the sentinel node (SN) will detect a significant number of SN metastases in patients with thin melanoma and that certain clinical or histopathologic factors may serve as predictors of SN tumor involvement.

Methods: Over 6 years, 349 patients with melanoma underwent LM/SL and were prospectively entered into an institutional review board (IRB)-approved database. LM/SL was performed with a combined radiotracer and blue dye technique. SNs were serially sectioned, and each section was examined by a dermatopathologist at multiple levels with hematoxylin and eosin as well as immunohistochemical stains.

Results: One hundred forty-six patients (42%) had a melanoma with Breslow thickness ≤1.0 mm; six (4%) of these 146 patients had a tumor-involved SN. On multivariate analysis, none of the clinical or histopathologic factors examined were significantly associated with SN tumor involvement in patients with thin melanoma. Completion lymphadenectomy was performed on all patients with a tumor-involved SN. None of the patients had non-SN tumor involvement.

Conclusions: The incidence of SN tumor involvement in patients with thin melanoma is considerable. Although we were unable to identify predictors of SN tumor involvement in patients with thin melanoma, efforts to identify predictors of SN tumor involvement should continue. Until better predictors are identified, we continue to advocate offering LM/SL to patients with thin melanomas who demonstrate clinical or histopathologic characteristics that have historically been associated with an increased risk of recurrence and mortality.

Key Words: Incidence • Lymphatic mapping • Sentinel node • Staging • Thin melanoma




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