Long-term follow-up reveals that ulceration and sentinel lymph node status are the strongest predictors for survival in patients with primary cutaneous melanoma

Abstract

, et al.. Long-term followup reveals that ulceration and sentinel lymph node status are the strongest predictors for survival in patients with primary cutaneous melanoma. EJSO -European Journal of Surgical Oncology, WB Saunders, 2011, 37 (8) This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. 124 Patients (29%) relapsed during follow-up; 55 in the node-positive group who underwent CLND (55/119;46%) and 69 in the node-negative group (69/310;22%;p<0.001). In the node-negative group 17 patients developed recurrence in the regional node field; false-negative rate 11%.On multivariate analysis strongest prognostic factors for disease free survival (DFS) were primary melanoma ulceration and SLN positivity (Hazard Ratio (HR) of 2.2 and 2.3; p<0.001). For disease specific survival (DSS) the same was found to be true with a HR of 2.1 for ulceration and 2.0 for SLN positivity (p=0.001 and p=0.002 respectively). 10-Year DFS was 71% for node-negative patients compared with 48% for node-positive patients (p<0.001). 10-Year DSS was 77% for node-negative patients compared to 60% for node-positive patients (p<0.001).Conclusions: This study shows a remarkably high percentage of tumor-positive SLN. The long-term follow-up data confirm that tumor-positive SLN patients have a worse DFS and DSS than tumornegative SLN patients. Ulceration and SLN status proved to be the strongest prognostic factors for long-term DFS and DSS.

Advocating Sentinel Node Biopsy in the Management of Cutaneous Melanoma

“…Two large prospective studies, the Sunbelt Melanoma Trial [28] and the MSLT-1 [29•], have reported complications rates of 4.6 % and 10 %, respectively, in patients with SNB alone, as opposed to those undergoing completion LND (23.2 % and 37.2 %). Recent institutional series with long-term follow-up are consistent with earlier studies, showing complications rates of 6.9 % for SNB [16].…”

“…A positive SNB has been consistently found to be one of the strongest prognostic factors in melanoma patients, followed by Breslow thickness, ulceration status [16,17] and, recently proposed, mitotic rate [18]. In Balch et al's [19•] recent study, nodal status as well as the extent of regional metastatic involvement [one positive sentinel node (N1a) compared to two or three sentinel nodes (N2a)] was shown to have significant prognostic value.…”

Tumor Mitotic Rate Added to the Equation: Melanoma Prognostic Factors Changed?

“…Accordingly, the aim was to investigate whether the addition of TMR to the survival analysis caused any changes in the prognostic factors for survival established previously for this cohort. 6 As was the case for the association TMR and SLNB, increasing TMR was found to be a strong predictive factor for decreased survival univariately for all categorization methods and particularly for TMR method A. This finding could not be reproduced in a multivariate model for all TMR methods.…”

“…6 However, these analyses were conducted without taking the TMR into account. The current study aimed to investigate the predictive value of TMR and other current pathologic features of melanoma regarding sentinel lymph node status and melanoma survival.…”

Prognostic Implication of Lymphovascular Invasion Detected by Double Immunostaining for D2-40 and MITF1 in Primary Cutaneous Melanoma

“…[3][4][5][6][7][8][9][10] This discrepancy may be due to the difficulties associated with accurately identifying LVI with H&E staining alone, particularly in thick melanomas, where tumoral occlusion of vascular lumina can preclude LVI identification. Also, immunohistochemical staining is routinely used for SLN evaluation but not for LVI.…”