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Original Article |
1 Department of Surgery, Hospital of the University of Pennsylvania, 4th Floor, Silverstein Pavilion, 3400 Spruce Street, Philadelphia, Pennsylvania 19104
2 Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, 631 Blockley Hall, 423 Guardian Drive, Philadelphia, Pennsylvania 19104
3 Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, Pennsylvania 19104
4 Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 6th Floor, Founders Building, 3400 Spruce Street, Philadelphia, Pennsylvania 19104
5 Pigmented Lesion Group and Melanoma Program, Abramson Cancer Center of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, Pennsylvania 19104
6 Department of Dermatology, Hospital of the University of Pennsylvania, 2nd Floor, Rhoads Building, 3400 Spruce Street, Philadelphia, Pennsylvania 19104
7 Department of Medicine, Division of Hematology and Oncology, Hospital of the University of Pennsylvania, 519 Maloney Building, 3400 Spruce Street, Philadelphia, Pennsylvania 19104
Correspondence: Address correspondence and reprint requests to: Francis R. Spitz, MD; E-mail: francis.spitz{at}uphs.upenn.edu.
Background: Lymphatic mapping and sentinel lymphadenectomy (LM/SL) provide important prognostic information for patients with early-stage melanoma. Although the use of this technique in patients with thin melanomas (
1.00 mm) is not routine, risk factors that may predict sentinel lymph node (SLN) positivity in this patient population are under investigation. We sought to determine whether mitotic rate (MR) is associated with SLN positivity in thin-melanoma patients and, therefore, whether it may be used to risk-stratify and select patients for LM/SL.
Methods: Clinical and histopathologic variables were reviewed for 181 patients with thin melanomas who underwent LM/SL from January 1996 through January 2004. Univariate and multivariate logistic regression analyses were performed to identify factors associated with SLN positivity. Risk groups were defined on the basis of the development of a classification tree.
Results: The overall SLN positivity rate was 5%. All patients with positive SLNs had an MR of >0. By univariate analysis, MR and thickness were significant predictors of SLN positivity. The association between MR and SLN positivity remained significant controlling for each of the other variables evaluated. On the basis of a classification tree, patients with an MR >0 and tumor thickness 
.76 mm were identified as a higher-risk group, with an SLN positivity rate of 12.3%.
Conclusions: In patients with thin melanomas, MR >0 seems to be a significant predictor of SLN positivity that may be used to risk-stratify and select patients for LM/SL. To confirm these results, the predictive value of MR for SLN positivity needs to be validated in other populations of thin-melanoma patients.
Key Words: Thin melanomas • Sentinel lymphadenectomy • Mitotic rate • Tumor-thickness • SLN positivity
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