Annals of Surgical Oncology, Vol 7, Issue 4 262-267, Copyright © 2000 by Society of Surgical Oncology

ARTICLES

Incidence of sentinel node metastasis in patients with thin primary melanoma (< or = 1 mm) with vertical growth phase

I. Bedrosian, M. B. Faries, D. Guerry 4th, R. Elenitsas, L. Schuchter, R. Mick, F. R. Spitz, L. P. Bucky, A. Alavi, D. E. Elder, D. L. Fraker and B. J. Czerniecki
Department of Surgery, University of Pennsylvania, Philadelphia 19104, USA.

BACKGROUND: Patients with thin primary melanomas (< or = 1 mm) generally have an excellent prognosis. However, the presence of a vertical growth phase (VGP) adversely impacts the survival rate. We report on the rate of occurrence of nodal metastasis in patients with thin primary melanomas with a VGP who are offered sentinel lymph node (SLN) biopsy. METHODS: Among 235 patients with clinically localized cutaneous melanomas who underwent successful SLN biopsy, 71 had lesions 1 mm or smaller with a VGP. The SLN was localized by using blue dye and a radiotracer. If negative for tumor by using hematoxylin and eosin staining, the SLN was further examined by immunohistochemistry. RESULTS: The rate of occurrence of SLN metastasis was 15.2% in patients with melanomas deeper than 1 mm and 5.6% in patients with thin melanomas. Three patients with thin melanomas and a positive SLN had low-risk lesions, based on a highly accurate six-variable multivariate logistic regression model for predicting 8-year survival in stage I/II melanomas. The fourth patient had a low- to intermediate-risk lesion based on this model. At the time of the lymphadenectomy, one patient had two additional nodes with metastasis. CONCLUSIONS: VGP in a melanoma 1 mm or smaller seems to be a risk factor for nodal metastasis. The risk of nodal disease may not be accurately predicted by the use of a multivariate logistic regression model that incorporates thickness, mitotic rate, regression, tumor-infiltrating lymphocytes, sex, and anatomical site. Patients with thin lesions having VGP should be evaluated for SLN biopsy and trials of adjuvant therapy when stage III disease is found.

This article has been cited by other articles:

				Y. Liu, C. Truini, and S. Ariyan A Randomized Study Comparing the Effectiveness of Methylene Blue Dye with Lymphazurin Blue Dye in Sentinel Lymph Node Biopsy for the Treatment of Cutaneous Melanoma Ann. Surg. Oncol., September 1, 2008; 15(9): 2412 - 2417. [Abstract] [Full Text] [PDF]

				S. Sassen, H. M. Shaw, M. H. Colman, R. A. Scolyer, and J. F. Thompson The Complex Relationships Between Sentinel Node Positivity, Patient Age, and Primary Tumor Desmoplasia: Analysis of 2303 Melanoma Patients Treated at a Single Center Ann. Surg. Oncol., February 1, 2008; 15(2): 630 - 637. [Abstract] [Full Text] [PDF]

				G. C. Karakousis, P. A. Gimotty, B. J. Czerniecki, D. E. Elder, R. Elenitsas, M. E. Ming, D. L. Fraker, D. Guerry, and F. R. Spitz Regional Nodal Metastatic Disease Is the Strongest Predictor of Survival in Patients with Thin Vertical Growth Phase Melanomas: A Case for SLN Staging Biopsy in These Patients Ann. Surg. Oncol., May 1, 2007; 14(5): 1596 - 1603. [Abstract] [Full Text] [PDF]

				P. A. Gimotty, D. E. Elder, D. L. Fraker, J. Botbyl, K. Sellers, R. Elenitsas, M. E. Ming, L. Schuchter, F. R. Spitz, B. J. Czerniecki, et al. Identification of High-Risk Patients Among Those Diagnosed With Thin Cutaneous Melanomas J. Clin. Oncol., March 20, 2007; 25(9): 1129 - 1134. [Abstract] [Full Text] [PDF]

				V. H. Stell, H. J. Norton, K. S. Smith, J. C. Salo, and R. L. White Jr. Method of Biopsy and Incidence of Positive Margins in Primary Melanoma Ann. Surg. Oncol., February 1, 2007; 14(2): 893 - 898. [Abstract] [Full Text] [PDF]

				D. Becker, M. C. Mihm, S. M. Hewitt, V. K. Sondak, J. W. Fountain, and M. Thurin Markers and Tissue Resources for Melanoma: Meeting Report. Cancer Res., November 15, 2006; 66(22): 10652 - 10657. [Abstract] [Full Text] [PDF]

				J. M. Ranieri, J. D. Wagner, S. Wenck, C. S. Johnson, and J. J. Coleman III The Prognostic Importance of Sentinel Lymph Node Biopsy in Thin Melanoma Ann. Surg. Oncol., July 1, 2006; 13(7): 927 - 932. [Abstract] [Full Text] [PDF]

				M. Grabacka, P. M. Plonka, K. Urbanska, and K. Reiss Peroxisome Proliferator-Activated Receptor {alpha} Activation Decreases Metastatic Potential of Melanoma Cells In vitro via Down-Regulation of Akt. Clin. Cancer Res., May 15, 2006; 12(10): 3028 - 3036. [Abstract] [Full Text] [PDF]

				G. C. Karakousis, P. A. Gimotty, J. D. Botbyl, S. B. Kesmodel, D. E. Elder, R. Elenitsas, M. E. Ming, D. Guerry, D. L. Fraker, B. J. Czerniecki, et al. Predictors of Regional Nodal Disease in Patients With Thin Melanomas Ann. Surg. Oncol., April 1, 2006; 13(4): 533 - 541. [Abstract] [Full Text] [PDF]

				M. I. Ross Early-stage melanoma: staging criteria and prognostic modeling. Clin. Cancer Res., April 1, 2006; 12(7): 2312s - 2319s. [Abstract] [Full Text] [PDF]

				S. L. Wong, M. S. Brady, K. J. Busam, and D. G. Coit Results of Sentinel Lymph Node Biopsy in Patients With Thin Melanoma Ann. Surg. Oncol., March 1, 2006; 13(3): 302 - 309. [Abstract] [Full Text] [PDF]

				J. Vaquerano, W. G. Kraybill, D. L. Driscoll, R. Cheney, and J. M. Kane III American Joint Committee on Cancer Clinical Stage as a Selection Criterion for Sentinel Lymph Node Biopsy in Thin Melanoma Ann. Surg. Oncol., February 1, 2006; 13(2): 198 - 204. [Abstract] [Full Text] [PDF]

				S. B. Kesmodel, G. C. Karakousis, J. D. Botbyl, R. J. Canter, R. T. Lewis, P. M. Wahl, K. P. Terhune, A. Alavi, D. E. Elder, M. E. Ming, et al. Mitotic Rate as a Predictor of Sentinel Lymph Node Positivity in Patients With Thin Melanomas Ann. Surg. Oncol., June 1, 2005; 12(6): 449 - 458. [Abstract] [Full Text] [PDF]

				K. B. Stitzenberg, P. A. Groben, S. L. Stern, N. E. Thomas, T. A. Hensing, L. B. Sansbury, and D. W. Ollila Indications for Lymphatic Mapping and Sentinel Lymphadenectomy in Patients with Thin Melanoma (Breslow Thickness <=1.0 mm) Ann. Surg. Oncol., October 1, 2004; 11(10): 900 - 906. [Abstract] [Full Text] [PDF]

				A.C. Halpern and A.A. Marghoob Thin Melanoma: Still "Excellent Prognosis" Disease? J. Clin. Oncol., September 15, 2004; 22(18): 3651 - 3653. [Full Text] [PDF]

				P. A. Gimotty, D. Guerry, M. E. Ming, R. Elenitsas, X. Xu, B. Czerniecki, F. Spitz, L. Schuchter, and D. Elder Thin Primary Cutaneous Malignant Melanoma: A Prognostic Tree for 10-Year Metastasis Is More Accurate Than American Joint Committee on Cancer Staging J. Clin. Oncol., September 15, 2004; 22(18): 3668 - 3676. [Abstract] [Full Text] [PDF]

				V. K. Sondak, J. M. G. Taylor, M. S. Sabel, Y. Wang, L. Lowe, A. C. Grover, A. E. Chang, A. M. Yahanda, J. Moon, and T. M. Johnson Mitotic Rate and Younger Age Are Predictors of Sentinel Lymph Node Positivity: Lessons Learned From the Generation of a Probabilistic Model Ann. Surg. Oncol., March 1, 2004; 11(3): 247 - 258. [Abstract] [Full Text] [PDF]

				I. A. Jacobs, C.K. Chang, T. K. DasGupta, and G. I. Salti Role of Sentinel Lymph Node Biopsy in Patients With Thin (<1 mm) Primary Melanoma Ann. Surg. Oncol., June 1, 2003; 10(5): 558 - 561. [Abstract] [Full Text] [PDF]

				J. B. Lowe, E. Hurst, J. F. Moley, and L. A. Cornelius Sentinel Lymph Node Biopsy in Patients With Thin Melanoma Arch Dermatol, May 1, 2003; 139(5): 617 - 621. [Abstract] [Full Text] [PDF]

				R. J. Bleicher, R. Essner, L. J. Foshag, L. A. Wanek, and D. L. Morton Role of Sentinel Lymphadenectomy in Thin Invasive Cutaneous Melanomas J. Clin. Oncol., April 1, 2003; 21(7): 1326 - 1331. [Abstract] [Full Text] [PDF]