| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Original Article |
1 Department of Surgical Oncology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
2 Department of Pathology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
Correspondence: Address correspondence and reprint requests to: Paul A. M. van Leeuwen, MD, PhD; E-mail: pam.vleeuwen{at}vumc.nl
Background: Even though 60% to 80% of melanoma patients with a positive sentinel lymph node (SLN) have no positive additional lymph nodes (ALNs), all these patients are subjected to an ALN dissection (ALND) with its associated morbidity. The aim of this study was to predict the absence of ALN metastases in patients with a positive SLN by using features of the primary melanoma and SLN tumor load.
Methods: Of 71 SLN-positive patients, 52 had metastasis limited to the SLN (group 1), and 19 had 
1 positive ALN after ALND (group 2). The tumor load of the SLN was assessed by measuring the total surface area by computerized morphometry. Breslow thickness, ulceration and lymphatic invasion of the primary tumor, and total SLN metastatic area were tested as covariates predicting the absence of positive ALNs.
Results: The mean SLN metastatic area was 1.18 mm2 (group 1) and 3.39 mm2 (group 2) (P = .003) and was the only significant and independent factor after multivariate analysis (P = .02). None of the patients with both a Breslow thickness <2.5 mm and an SLN metastatic area <.3 mm2 had a positive ALN.
Conclusions: SLN metastatic area can be used to predict the absence of positive ALNs in melanoma patients. In this study, patients with a Breslow thickness <2.5 mm and an SLN tumor load <.3 mm2 seemed to have no positive ALN and had excellent survival. We hypothesize that this subgroup might not benefit from ALND. Prospective larger trials, using this model and randomizing between ALND and no ALND, should confirm this hypothesis.
Key Words: Sentinel lymph node • Melanoma • Additional lymph node • Metastatic area
This article has been cited by other articles:
 |
|
 |
|
  J. E. Gershenwald, R. H.I. Andtbacka, V. G. Prieto, M. M. Johnson, A. H. Diwan, J. E. Lee, P. F. Mansfield, J. N. Cormier, C. W. Schacherer, and M. I. Ross Microscopic Tumor Burden in Sentinel Lymph Nodes Predicts Synchronous Nonsentinel Lymph Node Involvement in Patients With Melanoma J. Clin. Oncol., September 10, 2008; 26(26): 4296 - 4303. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Satzger, B. Volker, A. Meier, A. Kapp, and R. Gutzmer Criteria in Sentinel Lymph Nodes of Melanoma Patients that Predict Involvement of Nonsentinel Lymph Nodes Ann. Surg. Oncol., June 1, 2008; 15(6): 1723 - 1732. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. R. Rossi, G. L. De Salvo, E. Bonandini, S. Mocellin, M. Foletto, S. Pasquali, P. Pilati, M. Lise, D. Nitti, E. Rizzo, et al. Factors Predictive of Nonsentinel Lymph Node Involvement and Clinical Outcome in Melanoma Patients With Metastatic Sentinel Lymph Node Ann. Surg. Oncol., April 1, 2008; 15(4): 1202 - 1210. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. L. Morton, R. P. Scheri, and C. M. Balch Can completion lymph node dissection be avoided for a positive sentinel node in melanoma? Ann. Surg. Oncol., September 1, 2007; 14(9): 2437 - 2439. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Scolyer, R Murali, J. Gershenwald, A. Cochran, and J. Thompson Clinical relevance of melanoma micrometastases in sentinel nodes: too early to tell Ann. Onc., April 1, 2007; 18(4): 806 - 808. [Full Text] [PDF]
|
|
|
|
|
|
A. van Akkooi, J. de Wilt, C Verhoef, P. Schmitz, A. van Geel, A. Eggermont, and M Kliffen Clinical relevance of melanoma micrometastases (<0.1 mm) in sentinel nodes: are these nodes to be considered negative? Ann. Onc., October 1, 2006; 17(10): 1578 - 1585. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
