Five years of sentinel node biopsy for melanoma: the St George's Melanoma Unit experience

Topping, Adam; Dewar, Donald; Rose, Victoria; Cavale, Naveen; Allen, Rosemary; Cook, Martin; Powell, Barry

doi:10.1016/j.bjps.2003.03.002

Cited by 36 publications

(26 citation statements)

References 33 publications

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“…The presence of regression as inclusion criteria for SNB is also questionable; it has been described either as an unfavourable 44 • 45 or as a protective 46 prognostic factor. Moreover, Topping et al 47 reported in their study that ail patients having histological features of regression had a negative SN. In our study ail the patients presenting with regression associated with a Breslow thickness ::;1 mm (n = 16) had a negative SN and did not relapse.…”

Section: Indications Of Sentine[ Node Biopsymentioning

confidence: 99%

Prognostic value of sentinel node biopsy in 327 prospective melanoma patients from a single institution

Roulin

Matter

Bady

et al. 2008

European Journal of Surgical Oncology (EJSO)

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Aim: To confirm the accuracy of sentine! node biopsy (SNB) procedure and its morbidity, and to investigate predictive factors for SN status and prognostic factors for disease-free survival (DFS) and disease-specific survival (DSS). Materials and methods: Between October 1997 and December 2004, 327 consecutive patients in one centre with clinically node-negative primary skin melanoma underwent an SNB by the triple technique, i.e. lymphoscintigraphy, blue-dye and gamma-probe. Multivariate logistic regression analyses as well as the Kaplan-Meier were performed. Results: Twenty-three percent of the patients had at least one metastatic SN, which was significantly associated with Breslow thickness (p < 0.001). The success rate of SNB was 99.1 % and its morbidity was 7.6%. With a median follow-up of 33 months, the 5-year DFS/ DSS were 43%/49% for patients with positive SN and 83.5%/87.4% for patients with negative SN, respectively. The false-negative rate of SNB was 8.6% and sensitivity 91.4%. On multivariate analysis, DFS was significantly worsened by Breslow thickness (RR = 5.6, p < 0.001), positive SN (RR = 5.0, p < 0.001) and male sex (RR = 2.9, p = 0.001). The presence of a metastatic SN (RR = 8.4, p < 0.001), male sex (RR = 6.1,p < 0.001), Breslow thickness (RR = 3.2,p = 0.013) and ulceration (RR = 2.6,p = 0.015) were significantly associated with a poorer DSS. Conclusion: SNB is a reliable procedure with high sensitivity (91.4%) and low morbidity. Breslow thickness was the only statistically significant parameter predictive of SN status. DFS was worsened in decreasing order by Breslow thickness, metastatic SN and male gender. Similarly DSS was significantly worsened by a metastatic SN, male gender, Breslow thickness and ulceration. These data reinforce the SN status as a powerful staging procedure. © 2007 Elsevier Ltd. All rights reserved.Keywords: Melanoma; Sentine! lymph node; Prognostic factors; Survival Introduction Sentinel node biopsy (SNB) is an important staging procedure and may be a potential therapeutic approach in the management of melanoma. Metastatic spreading from a primary melanoma can be explained by two possible theories. 1 In the "marker" hypothesis, the primary melanoma metastasizes * Corresponding author. Tel.: +41 21 314 23 54; fax: +41 2131428 51. E-mail address: maurice.matter@chuv.ch (M. Matter).0748-7983/$ -see front malter © 2007 Elsevier Ltd. Ali rights reserved. doi: 10.1016Ali rights reserved. doi: 10. /j.ejso.2007 simultaneously via lymphatic and haematogenous routes, so that the presence of regional lymph nodes metastases becomes a marker of the likelihood of systemic disease. In the "incubator" hypothesis, the primary melanoma targets regional lymph nodes where metastatic cells may survive and slowly grow but remain latent before spreading to distant sites. According to this second theory, it was suggested that early removal of involved regional lymph nodes in earlyand intermediate-stage melanoma could prevent the progression of the metastases and thus improve survival...

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Section: Indications Of Sentine[ Node Biopsymentioning

confidence: 99%

Prognostic value of sentinel node biopsy in 327 prospective melanoma patients from a single institution

Roulin

Matter

Bady

et al. 2008

European Journal of Surgical Oncology (EJSO)

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“…109 Similar results have been reported by other groups, including two separate studies of 48 melanomas of the extremities (Breslow thickness ≤ 1.00 mm) 82,84 and a study of 347 cases of melanoma. 88 In a recent study of 1349 cutaneous melanomas, however, Morris et al 106 showed that regression correlated with decreased local and systemic recurrence.…”

Section: Association Between Regression and Recurrencementioning

confidence: 99%

“…In contrast, some authors showed that the presence of regression in primary melanomas was not associated with lymph node metastasis. 2,86,[88][89][90][91][92][93][94][95][96][97] Some studies have demonstrated a lack of correlation between extent of regression and SLN status. 2,4,7,76,82 Yet other studies have reported that the presence of regression may be associated with negative SLN status.…”

Section: Association Between Regression and Recurrencementioning

confidence: 99%

Regression in primary cutaneous melanoma: etiopathogenesis and clinical significance

Aung

Nagarajan

Prieto

2017

Laboratory Investigation

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Though not required currently for staging, regression is a histopathologic parameter typically reported upon diagnosis of an invasive primary cutaneous melanoma. The studies examining the prognostic significance of regression in patient outcome have yielded controversial findings; likely because the definition and assessment of regression have not been consistent, in addition to subjectivity of pathologists' interpretation. Regression is histologically characterized by variable decrease in the number of melanoma cells accompanied by the presence of a host response consisting of dermal fibrosis, inflammatory infiltrate, melanophages, ectatic blood vessels, epidermal attenuation, and/or apoptosis of keratinocytes or melanocytes; the relative extent of these features depends on the stage of the regression. However, the magnitudes to which these individual changes must be present to meet the threshold of histologic regression have not been well defined or agreed upon, and thus, the definition and classification of histologic regression in melanoma varies considerably among institutions and even among individual pathologists. In order to determine the clinical significance of histologic analysis of regression, there is a compelling need for a universal scheme to objectively define and assess histologic regression in primary cutaneous melanoma, so that the biologic and prognostic significance of this process may be completely understood.

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“…[60][61][62][63] Those against the procedure emphasize the lack of randomized controlled trials that demonstrate therapeutic value alone or in combination with adjuvant medical or surgical therapy, including interferon or CLND for SLN-positive disease. [60][61][62] Some also * References 4,23,24,26,[28][29][30][31]35,36,[44][45][46][48][49][50][51]26,[29][30][31]44,45,50,52,53. ‡References 16,17,23,24,26,28,30,36,46,48,50,53.…”

Section: Commentmentioning

confidence: 99%

Sentinel Lymph Node Biopsy for Cutaneous Melanoma

Berk

Johnson²,

Uzieblo³

et al. 2005

Arch Dermatol

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Five years of sentinel node biopsy for melanoma: the St George's Melanoma Unit experience

Cited by 36 publications

References 33 publications

Prognostic value of sentinel node biopsy in 327 prospective melanoma patients from a single institution

Prognostic value of sentinel node biopsy in 327 prospective melanoma patients from a single institution

Regression in primary cutaneous melanoma: etiopathogenesis and clinical significance

Sentinel Lymph Node Biopsy for Cutaneous Melanoma

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