Factors Predictive of the Status of Sentinel Lymph Nodes in Melanoma Patients from a Large Multicenter Database

Abstract

Background Numerous predictive factors for cutaneous melanoma metastases to sentinel lymph nodes have been identified; however, few have been found to be reproducibly significant. This study investigated the significance of factors for predicting regional nodal disease in cutaneous melanoma using a large multicenter database. Methods Seventeen institutions submitted retrospective and prospective data on 3463 patients undergoing sentinel lymph node (SLN) biopsy for primary melanoma. Multiple demographic and tumor factors were analyzed for correlation with a positive SLN. Univariate and multivariate statistical analyses were performed. Results Of 3445 analyzable patients, 561 (16.3%) had a positive SLN biopsy. In multivariate analysis of 1526 patients with complete records for 10 variables, increasing Breslow thickness, lymphovascular invasion, ulceration, younger age, the absence of regression, and tumor location on the trunk were statistically significant predictors of a positive SLN. Conclusions These results confirm the predictive significance of the well-established variables of Breslow thickness, ulceration, age, and location, as well as consistently reported but less well-established variables such as lymphovascular invasion. In addition, the presence of regression was associated with a lower likelihood of a positive SLN. Consideration of multiple tumor parameters should influence the decision for SLN biopsy and the estimation of nodal metastatic disease risk.

Is ulceration in cutaneous melanoma just a prognostic and predictive factor or is ulcerated melanoma a distinct biologic entity?

“…It has recently been demonstrated that lymphovascular invasion is also strongly correlated with ulceration [8]. It is no surprise then that ulcerated melanomas show an increased sentinel lymph-node positivity rate in patients with melanomas more than 1 mm and also in patients with thin melanomas [9,10].…”

Multiple Lymph Node Basin Drainage in Trunk Melanoma Is Not Associated with Survival of Sentinel Lymph Node-Positive Patients

“…Many studies have established the role of younger age, greater Breslow thickness, ulceration, and tumour mitotic rate in predicting SLN metastases [3][4][5] .…”

Microphthalmia transcription factor in malignant melanoma predicts occult sentinel lymph node metastases and survival

“…In a multicenter retrospective and prospective study, White et al [16] confirmed the synchronicity of Breslow thickness greater than 2 mm, ulceration, absence of regression, younger age, and trunk location as wellestablished predictive factors of lymph node involvement, and of lymphatic invasion as a less well-established variable. More recently, other means were put to test to assess the metastatic spread on the basis of the characteristics of the primary melanoma tumor such as the extent of lymphangiogenesis.…”

“…Current studies are based on specific characteristics of the primary melanoma tumor [13][14][15][16][17][18] or on measurement of related serum biomarkers as an alternative to sentinel lymph node (SLN) biopsy [19,20].…”