Excision margins and sentinel lymph node status as prognostic factors in thick melanoma of the head and neck: A retrospective analysis

Ruskin, Olivia; Sanelli, Alexandra; Herschtal, Alan; Webb, Angela; Dixon, Ben; Pohl, Miklos; Donahoe, Simon; Spillane, John; Henderson, Michael A.; Gyorki, David E.

doi:10.1002/hed.24444

Cited by 9 publications

(7 citation statements)

References 29 publications

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“…Most tumors in our study were ulcerated, and this feature was not associated with PFS or OS. Similar results were noted by Blakely A. et al [26], Ruskin O. et al [43], Yamamoto M. et al [45], and Gyorki D.E. et al [46], while Rodriguez Otero J.C. et al [33] and Bello D. et al [36] found ulceration to be a significant adverse prognostic factor only in univariate analysis.…”

Section: Discussionsupporting

confidence: 81%

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The Impact of Clinical and Histopathological Factors on Disease Progression and Survival in Thick Cutaneous Melanomas

Țăpoi,

Derewicz,

Gheorghișan-Gălățeanu

et al. 2023

Biomedicines

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Thick cutaneous melanomas (Breslow depth > 4 mm) are locally advanced tumors, generally associated with poor prognosis. Nevertheless, these tumors sometimes display unpredictable behavior. This study aims to analyze clinical and histopathological features that can influence the prognosis of thick melanomas. This is a retrospective study on 94 thick primary cutaneous melanomas diagnosed between 2012 and 2018 that were followed-up for at least five years to assess disease progression and survival. We evaluated the age, gender, tumor location, histological subtype, Breslow depth, Clark level, resection margins, mitotic index, the presence/absence of ulceration, necrosis, regression, microsatellites, neurotropism, lymphovascular invasion, and the pattern of tumor-infiltrating lymphocytes, and their association with disease progression and survival. By conducting univariate analysis, we found that progression-free survival (PFS) was significantly associated with female gender, the superficial spreading melanoma (SSM) subtype, mitotic index, necrosis, microsatellites, and perineural invasion. Overall survival (OS) was significantly associated with female gender, Breslow depth, SSM subtype, necrosis, microsatellites, and perineural invasion. Through multivariate Cox proportional hazards regression, we found that the only factors associated with PFS were Breslow depth, necrosis, microsatellites, and perineural invasion, while the factors associated with OS were Breslow depth, necrosis, microsatellites, and perineural invasion. Certain histopathological features such as Breslow depth, necrosis, microsatellites, and perineural invasion could explain differences in disease evolution. This is one of the first studies to demonstrate an association between necrosis and perineural invasion and outcomes in patients with thick melanomas. By identifying high-risk patients, personalized therapy can be provided for improved prognosis.

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Section: Discussionsupporting

confidence: 81%

“…However, these findings were not confirmed by multivariate analyses. These results concord with some studies about thick cutaneous melanomas [26,41,43,44]. On the contrary, other authors demonstrated that mitotic rate is associated with progressive disease and decreased OS.…”

Section: Discussionsupporting

confidence: 81%

The Impact of Clinical and Histopathological Factors on Disease Progression and Survival in Thick Cutaneous Melanomas

Țăpoi,

Derewicz,

Gheorghișan-Gălățeanu

et al. 2023

Biomedicines

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“…There were no differences in disease‐free survival and local recurrence between the two groups. In contrast, another single‐center study on T4 CMHN found a high rate of locoregional recurrence (27%), but margins ≥2 cm failed to offer any benefit in recurrence rates or MSS 3 …”

Section: Literature Reviewmentioning

confidence: 87%

“…In contrast, another single-center study on T4 CMHN found a high rate of locoregional recurrence (27%), but margins ≥2 cm failed to offer any benefit in recurrence rates or MSS. 3 Alternative techniques to WLE such as Mohs micrographic surgery (MMS) and staged excision (SE) have gained acceptance due to their reliance on histopathologic rather than clinical margins. MMS and SE allows for comprehensive margin assessment which can be utilized for tumors with clinically ill-defined margins in sensitive locations such as the lip and peri-ocular area.…”

Section: Literature Reviewmentioning

confidence: 99%

Head and Neck Melanoma: What is the Goal for Margins?

et al. 2021

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“…Three low-quality retrospective cohort studies were identified to directly inform this recommendation for invasive (pT1-pT4) melanoma. All three reviewed the medical records of patients diagnosed with melanoma located on the head and neck and found no difference in survival rates [21][22][23] or recurrence rates 22,23 when margins of different sizes were compared.…”

Section: Key Evidence and Interpretationmentioning

confidence: 99%

Primary Excision Margins, Sentinel Lymph Node Biopsy, and Completion Lymph Node Dissection in Cutaneous MelanomA: A Clinical Practice Guideline

et al. 2019

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Background For patients who are diagnosed with early-stage cutaneous melanoma, the principal therapy is wide surgical excision of the primary tumour and assessment of lymph nodes. The purpose of the present guideline was to update the 2010 Cancer Care Ontario guideline on wide local excision margins and sentinel lymph node biopsy (SLNB), including treatment of the positive sentinel node, for melanomas of the trunk, extremities, and head and neck.Methods Using Ovid, the MEDLINE and EMBASE electronic databases were systematically searched for systematic reviews and primary literature evaluating narrow compared with wide excision margins and the use of SLNB for melanoma of the truck and extremities and of the head and neck. Search timelines ran from 2010 through week 25 of 2017.Results Four systematic reviews were chosen for inclusion in the evidence base. Where systematic reviews were available, the search of the primary literature was conducted starting from the end date of the search in the reviews. Where systematic reviews were absent, the search for primary literature ran from 2010 forward. Of 1213 primary studies identified, 8 met the inclusion criteria. Two randomized controlled trials were used to inform the recommendation on completion lymph node dissection.Key updated recommendations include:■ Wide local excision margins should be 2 cm for melanomas of the trunk, extremities, and head and neck that exceed 2 mm in depth.■ SLNB should be offered to patients with melanomas of the trunk, extremities, and head and neck that exceed 0.8 mm in depth.■ Patients with sentinel node metastasis should be considered for nodal observation with ultrasonography rather than for completion lymph node dissection.Conclusions Recommendations for primary excision margins, sentinel lymph node biopsy, and completion lymph node dissection in patients with cutaneous melanoma have been updated based on the current literature.

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Excision margins and sentinel lymph node status as prognostic factors in thick melanoma of the head and neck: A retrospective analysis

Abstract: Wider margins do not significantly improve locoregional recurrence or MSS. Sentinel lymph node involvement reflects a poor prognosis. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1373-1379, 2016.

Cited by 9 publications

References 29 publications

The Impact of Clinical and Histopathological Factors on Disease Progression and Survival in Thick Cutaneous Melanomas

The Impact of Clinical and Histopathological Factors on Disease Progression and Survival in Thick Cutaneous Melanomas

Head and Neck Melanoma: What is the Goal for Margins?

Primary Excision Margins, Sentinel Lymph Node Biopsy, and Completion Lymph Node Dissection in Cutaneous MelanomA: A Clinical Practice Guideline

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