A cohort analysis of surgically treated primary head and neck lentigo maligna (melanoma): Prognostic value of melanoma subtype and new insights in the clinical value of guideline adherence

Elshot, Yannick S.; Zupan-Kajcovski, Biljana; Ouwerkerk, Wouter; Klop, William M. C.; Lohuis, Peter J. F. M.; Bol, Mijke; Crijns, Marianne B.; Bekkenk, Marcel W.; Rie, Menno A. de; Balm, Alfons J. M.

doi:10.1016/j.ejso.2022.08.012

Cited by 3 publications

(4 citation statements)

References 40 publications

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“…Furthermore, studies using the NCDB have been observed to overestimate the risk of nodal positivity in patients with melanomas, 36 which could certainly apply to our study as well. Although previous studies do not necessarily report high false negative rates specifically for LMM, 31 this could add to the limitations for interpreting our results. Most cases in our datasets lack information about the specific anatomic location of LMM on the head and neck, a worthwhile subject of further research.…”

Section: Discussionmentioning

confidence: 69%

“…Although previous studies do not necessarily report high false negative rates specifically for LMM, 31 were <50 years old (median age of 75 years), which is expected in LMM considering it is a disease of the elderly. This likely confounds our ability to appropriately analyze the risk of nodal metastasis in the younger cohort.…”

Section: Discussionmentioning

confidence: 74%

“…Historically, due to a lower risk of SLN positivity in LMM, 31,32 judicious patient selection has been recommended. This analysis found an 8%−11% rate of SLN positivity overall, which was higher for Taken together, these findings highlight the important prognostic and treatment-related benefit of performing SLNB in affected LMM patients.…”

Section: Discussionmentioning

confidence: 99%

“…Historically, due to a lower risk of SLN positivity in LMM, 31,32 judicious patient selection has been recommended. This analysis found an 8%−11% rate of SLN positivity overall, which was higher for tumors with ulceration, LVI, mitosis, and increased thickness.…”

Section: Discussionmentioning

confidence: 99%

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Is sentinel lymph node biopsy needed for lentigo maligna melanoma?

Kakish,

Lal,

Thuener

et al. 2023

Journal of Surgical Oncology

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Background and ObjectivesSentinel lymph node biopsy (SLNB) is an area of debate in the management of lentigo maligna melanoma (LMM). The utility of SLNB and its prognostic value in LMM have not yet been studied with large databases.MethodsWe performed a retrospective review of the National Cancer Database (2012−2020) and the Surveillance, Epidemiology, and End Results (2010−2019) database for patients with cutaneous nonmetastatic LMM with Breslow thickness >1.0 mm. Multivariable logistic regression identified factors associated with SLNB performance and sentinel lymph node (SLN) positivity. Univariable and multivariable analyses assessed overall survival (OS) and melanoma‐specific survival (MSS) based on SLNB performance and SLN status.ResultsCompared to other melanoma subtypes, LMM had lower rates of SLNB (66.6% vs. 80.0%−84.0%) and SLN positivity (11.3% vs. 18.6%−34.2%). Compared to patients who did not undergo SLNB, SLN status was significantly associated with improved OS in patients with SLN positive (HR = 0.64 [0.55−0.76]) and SLN negative (HR = 0.68 [0.49−0.94]), and worse MSS only in patients with positive SLN (HR = 3.93, p < 0.05).ConclusionThe improved OS associated with SLNB likely implies surgical selection bias. Analysis of MSS confirms appropriate patient selection and suggests important prognostic value associated with SLN status. These results support continued SLNB for LMM patients according to standard guidelines.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

“…Historically, due to a lower risk of SLN positivity in LMM, 31,32 judicious patient selection has been recommended. This analysis found an 8%−11% rate of SLN positivity overall, which was higher for tumors with ulceration, LVI, mitosis, and increased thickness.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Is sentinel lymph node biopsy needed for lentigo maligna melanoma?

Kakish,

Lal,

Thuener

et al. 2023

Journal of Surgical Oncology

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Clinical, dermatoscopic, histological and molecular predictive factors of distant melanoma metastasis: A systematic review and meta-analysis

Lallas,

Kyrgidis,

Chrysostomidis

et al. 2024

Critical Reviews in Oncology/Hematology

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Successful implementation of handheld reflectance confocal microscopy as the standard of care in the (surgical) management of lentigo maligna (melanoma)

Elshot,

Lasso Peña,

Zupan‐Kajcovski

et al. 2024

Acad Dermatol Venereol

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BackgroundReflectance confocal microscopy (RCM) has shown promise in predicting surgical outcomes by non‐invasively detecting subclinical lentigo maligna (melanoma) (LM/LMM).ObjectivesTo assess the effects of presurgical mapping using handheld RCM (HH‐RCM) on surgical treatment, follow‐up outcomes and management decisions.MethodsA total of 117 consecutive LM/LMM cases (2015–2023) were included. The diagnostic accuracy of HH‐RCM in detecting subclinical LM and invasive components was evaluated. The primary endpoints included histological margin status and changes in management based on the outcomes of the HH‐RCM mapping procedure. Margin and follow‐up outcomes were compared to a historical cohort before HH‐RCM was introduced in our center (n = 94) (2003–2014).ResultsHH‐RCM detected subclinical LM in 60% (n = 60) of cases. The median mapping duration was 14 min (range 4–50). In 27% (n = 33), the mapping procedure resulted in modified management, the majority consisting of limited surgery with adjuvant imiquimod (n = 15) or imiquimod monotherapy (n = 14). The remaining cases (n = 84) underwent HH‐RCM‐assisted surgery. Histological margins were cleared in 96.5% of the patients with a median histological margin of 3.0 mm, significantly higher than 81% in the historical cohort (median 2.0 mm) (p = 0.001). The sensitivity and specificity for detecting the extent of subclinical LM were 94% (95% CI 80.4–99.3) and 84% (95% CI 70.3–92.7), respectively. The negative predictive value for the detection of LMM was 94% (95% CI 84.4–97.7), and 75% of the initially missed LMM (n = 12) were identified during the HH‐RCM mapping procedure. The study cohort had a 1.6% local recurrence rate compared with 25% in the historical cohort.ConclusionsIntegrating HH‐RCM as the standard of care could lead to more personalized treatment strategies for LM/LMM and allows for the selection of patients suitable for nonsurgical treatment.

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A cohort analysis of surgically treated primary head and neck lentigo maligna (melanoma): Prognostic value of melanoma subtype and new insights in the clinical value of guideline adherence

Cited by 3 publications

References 40 publications

Is sentinel lymph node biopsy needed for lentigo maligna melanoma?

Is sentinel lymph node biopsy needed for lentigo maligna melanoma?

Clinical, dermatoscopic, histological and molecular predictive factors of distant melanoma metastasis: A systematic review and meta-analysis

Successful implementation of handheld reflectance confocal microscopy as the standard of care in the (surgical) management of lentigo maligna (melanoma)

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