Melanoma thickness and histology predict sentinel lymph node status

Nguyen, Christophe; McClay, Ed F; Cole, David J.; O’Brien, Paul H.; Gillanders, William E.; Metcalf, John S.; Maize, John C.; Baron, Paul L.

doi:10.1016/s0002-9610(00)00533-x

Cited by 66 publications

(61 citation statements)

References 15 publications

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“…Evaluating Breslow depth alone, for lesions Ͻ1.0 mm in thickness, the published collective rate of SLN positivity is Ͻ5%. 2,7,8,13,16,18 In lesions Ͼ3.0 mm, the published rate of SLN positivity ranges from 20% to 50%. 2,7-10,13,16 -18,20,21,23 Several reports have studied other primary lesion factors associated with SLN status.…”

Section: Discussionmentioning

confidence: 99%

“…6 Breslow thickness (measured in millimeters) is the only reproducible factor predictive of SLN status in all studies. [1][2][3][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Several other factors have been variably and sometimes discordantly reported to have predictive value for SLN metastasis, including Clark level, ulceration, mitotic rate, microsatellitosis, angiolymphatic invasion, vertical growth phase, number of nodal basins, primary tumor location, and patient age. [1][2][3][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Several plausible explanations could account for the disparate and sometimes conflicting predictive models that have been offered to date.…”

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confidence: 99%

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Mitotic Rate and Younger Age Are Predictors of Sentinel Lymph Node Positivity: Lessons Learned From the Generation of a Probabilistic Model

et al. 2004

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Background: Sentinel lymph node (SLN) biopsy allows surgeons to identify patients with subclinical nodal involvement who may benefit from lymphadenectomy and, possibly, adjuvant therapy. Several factors have been variably, and sometimes discordantly, reported to have predictive value for SLN metastasis to best select which patients require SLN biopsy.Methods: We reviewed 419 patients who underwent SLN biopsy for melanoma from a prospectively collected melanoma database. To derive a probabilistic model for the occurrence of a positive SLN, a multivariate logistic model was fit by using a stepwise variable selection method. The accuracy of each model was evaluated by using receiver operator characteristic curves.Results: On univariate analysis, the number of mitoses per square millimeter, increasing Breslow depth, decreasing age, ulceration, and melanoma on the trunk showed a significant relationship to a positive SLN. Multivariate analysis revealed that once age, mitotic rate, and Breslow thickness were included, no other factor, including ulceration, was significantly associated with a positive SLN. The data suggest that younger patients with tumors Ͻ1 mm may still have a substantial risk for a positive SLN, especially if the mitotic rate is high.Conclusions: In addition to Breslow depth, mitoses per square millimeter and younger age were factors identified as independent predictors of a positive SLN. This model may identify patients with thin melanoma at sufficient risk for metastases to justify SLN biopsy.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Mitotic Rate and Younger Age Are Predictors of Sentinel Lymph Node Positivity: Lessons Learned From the Generation of a Probabilistic Model

et al. 2004

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“…In this context, a limit of ≥ 1 mm for the indication for SLNB is often cited. However, the risk for a positive sentinel lymph node rises continuously with increasing thickness of the primary tumor [146,148,156,157]. In a meta-analysis of 34 studies, a tumor thickness of < 1 mm was associated with a positive sentinel lymph node in 5.6 % of patients, with values ranging from 0-14.3 % [150].…”

Section: R Gutzmermentioning

confidence: 99%

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

Pflugfelder

Kochs

Blum

et al. 2013

J Deutsche Derma Gesell

181

148

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“…5,[7][8][9][10][11][12][13][14] Other factors, such as ulceration, Clark level IV/V, vertical growth phase (VGP), higher dermal mitotic rate (MR), blood and lymphatic vessel invasion, axial location, and younger age have all been cited with conflicting results. 5,[7][8][9][10][11][12][13][14][15][16][17][18][19][20] Our group evaluated prognostic factors within the context of a biological model of melanoma progression in which melanomas are hypothesized to evolve from cell populations incapable of metastasis (the in situ and invasive radial growth phase [RGP]) to those with variable metastatic potential (the VGP). [21][22][23][24] Histologic features such as VGP (defined below) and dermal mitotic rate are taken to indicate that a lesion may have gained the capacity to metastasize.…”

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confidence: 99%

Predicting sentinel node status in AJCC stage I/II primary cutaneous melanoma

Kruper

Spitz

Czerniecki

et al. 2006

Cancer

108

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BACKGROUND.Sentinel lymph node (SLN) status is an important prognostic factor for survival for patients with primary cutaneous melanoma. To address the issue of selecting patients at high and low risk for a positive SLN, prognostic factors were sought that predict SLN involvement by examining characteristics of both the primary tumor and the patient within the context of a biological model of melanoma progression.METHODS.The study included 682 patients with primary vertical growth phase (VGP) melanoma and no clinical evidence of metastatic disease who underwent SLN biopsy (1995–2003). Logistic regression and classification tree analyses were used to investigate the association between SLN positivity and Breslow thickness, Clark level, tumor infiltrating lymphocytes (TIL), ulceration, mitotic rate (MR), lesion site, gender, and age.RESULTS.In all, 88 of the 682 patients had ≥1 positive SLN (12.9%). In the multivariate analysis, MR, TIL, and thickness were found to be independent prognostic factors for SLN positivity. In the classification tree, four different risk groups were defined, ranging from minimal risk (2.1%) to high risk (40.4%). In lesions ≤2.0 mm, MR was important in risk‐stratifying patients, and in lesions >2.0 mm TIL was important.CONCLUSIONS.By incorporating biologically based variables such as VGP, TIL, and MR along with thickness into a prognostic model, both patients at high risk and minimal risk for SLN positivity can be identified. If validated, this model can be used in patient management and trial design to select patients to undergo or be spared SLN biopsy. Cancer 2006. © 2006 American Cancer Society.

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Melanoma thickness and histology predict sentinel lymph node status

Cited by 66 publications

References 15 publications

Mitotic Rate and Younger Age Are Predictors of Sentinel Lymph Node Positivity: Lessons Learned From the Generation of a Probabilistic Model

Mitotic Rate and Younger Age Are Predictors of Sentinel Lymph Node Positivity: Lessons Learned From the Generation of a Probabilistic Model

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

Predicting sentinel node status in AJCC stage I/II primary cutaneous melanoma

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