This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Shaw, H. M. Articles by Thompson, J. F. Search for Related Content PubMed PubMed Citation Articles by Shaw, H. M. Articles by Thompson, J. F.

Frequency of Nonsentinel Lymph Node Metastasis in Melanoma

Sydney Melanoma Unit, Royal Prince Alfred Hospital, Camperdown and Department of Surgery, The University of Sydney, NSW, Australia

To the Editor:

We read with interest the report from the Sunbelt Melanoma Trial (SMT) concerning the frequency of nonsentinel lymph node (NSLN) metastases.¹ It was concluded that because no patient population could be identified in which there was minimal risk of NSLN metastases, complete lymph node dissection (CLND) should be performed routinely on all patients found to have a positive sentinel lymph node (SLN). These results were based on patients entered from 46 different institutions across the United States. Because this wide accrual base may possibly have introduced an element of inconsistency in the SMT data, we considered it useful to analyze results drawn entirely from one institution, the Sydney Melanoma Unit (SMU). All SLN biopsies were performed by 1 of 5 SMU surgeons specializing in melanoma, and all primary tumors and lymph nodes were examined by 1 of 3 histopathologists specializing in melanoma.

The independent prognostic significance of tumor thickness and ulceration has been conclusively demonstrated in 17,600 patients,² and the SMU has recently demonstrated that in their dataset, tumor mitotic rate is also a dominant independent determinant of survival.³ We therefore extracted from the SMU database all patients who had a positive SLN biopsy followed by a CLND and in whom details of primary tumor thickness, ulceration, and mitotic rate were available. Table 1summarizes the results of this analysis on 191 patients from the SMU who satisfied these criteria together with the corresponding results on 274 patients from the SMT.

We initially thought that the proportion of SLNs that were found to be positive might predict the risk of detecting NSLN metastases. However, this did not prove to be the case. In those 31 patients who had a CLND that revealed NSLN metastases, 66 sentinel lymph nodes were removed, 39 of which contained metastases (59.1%). In those 160 patients who had a CLND that did not reveal NSLN metastases, 398 sentinel nodes were removed, 198 of which contained metastases (49.7%).

Our results are thus in agreement with those of the SMT, in that it is not possible, from the above features studied at least, to predict the risk of NSLN metastases.

REFERENCES

1. McMasters KM, Wong SL, Edwards MJ, et al. Frequency of nonsentinel lymph node metastasis in melanoma. Ann Surg Oncol 2002; 9: 137–41.[Abstract/Free Full Text]
2. Balch CM, Soong SJ, Gershenwald JE, et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer Melanoma Staging System. J Clin Oncol 2001; 19; 3622–34.[Abstract/Free Full Text]
3. Azzola MF, Shaw HM, Thompson JF, et al. Tumor mitotic rate is a more powerful prognostic indicator than ulceration in patients with primary cutaneous melanoma. An analysis of 3661 patients from a single center. Cancer (in press).

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]

				N. Elias, K. K. Tanabe, A. J. Sober, M. A. Gadd, M. C. Mihm, B. Goodspeed, and A. B. Cosimi Is Completion Lymphadenectomy After a Positive Sentinel Lymph Node Biopsy for Cutaneous Melanoma Always Necessary? Arch Surg, April 1, 2004; 139(4): 400 - 405. [Abstract] [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Shaw, H. M. Articles by Thompson, J. F. Search for Related Content PubMed PubMed Citation Articles by Shaw, H. M. Articles by Thompson, J. F.