Mitotic rate correlates with sentinel lymph node status and outcome in cutaneous melanoma greater than 1 millimeter in thickness: A multi-institutional study of 1524 cases

Mandalà, Mario; Galli, Francesca; Cattaneo, Laura; Merelli, Barbara; Rulli, Eliana; Ribero, Simone; Quaglino, Pietro; Giorgi, Vincenzo De; Pigozzo, Jacopo; Sileni, V. Chiarion; Chirco, Alessandra; Ferrucci, Pier Francesco; Occelli, Marcella; Imberti, Gianlorenzo; Piazzalunga, Dario; Massi, Daniela; Tondini, Carlo; Queirolo, Paola

doi:10.1016/j.jaad.2016.08.066

Cited by 40 publications

(32 citation statements)

References 18 publications

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“…Older age was also associated with worse RFS and MSS whereas it was not associated with SLN positivity. In a recently reported multi‐institutional study of 1524 patients with cutaneous melanoma greater than 1 mm in thickness also showed a similar result; older age was not associated with SLN positivity but was associated with worse DFS and OS .…”

Section: Discussionmentioning

confidence: 53%

Clinical impact of ulceration width, lymphovascular invasion, microscopic satellitosis, perineural invasion, and mitotic rate in patients undergoing sentinel lymph node biopsy for cutaneous melanoma: a retrospective observational study at a comprehensive cancer center

et al. 2018

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The prognostic significance of the width of the ulceration in primary melanomas remains unclear, and there is a relative paucity of data for lymphovascular invasion (LVI), microscopic satellitosis (MS), perineural invasion (PNI), and mitotic rate when compared with other pathological elements currently required for reporting. To evaluate the prognostic importance of the ulceration width and other important pathologic measurements, a single‐institutional retrospective study was conducted using records of cutaneous melanoma patients who underwent sentinel lymph node (SLN) biopsy at The University of Texas, MD Anderson Cancer Center between 2003 and 2008. We identified 1898 eligible patients with median tumor thickness of 1.25 mm and median follow‐up of 6.7 years. By multivariable analyses, the strongest risk factor for SLN positivity was high tumor thickness followed by the presence of LVI. The pathologic measures with the strongest influence on recurrence‐free survival (RFS) were tumor thickness and positive SLN status. Ulceration width and presence of MS were also significantly associated with RFS while PNI was not. Factors with the strongest influence on melanoma‐specific survival (MSS) were positive SLN status and mitotic rate. In conclusion, SLN biopsy should probably be offered if the primary tumor has LVI. MS is an adverse prognostic factor for RFS, but its influence on outcome is modest. Ulceration width predicts RFS but loses its independent prognostic significance for MSS when adjusting for currently used clinicopathological factors. In view of its impact on MSS, mitotic rate should be recorded for cutaneous invasive melanomas across all T categories.

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Section: Discussionmentioning

confidence: 53%

Clinical impact of ulceration width, lymphovascular invasion, microscopic satellitosis, perineural invasion, and mitotic rate in patients undergoing sentinel lymph node biopsy for cutaneous melanoma: a retrospective observational study at a comprehensive cancer center

et al. 2018

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“…Although the mitotic rate is not included in the T1 subcategory criteria of the eighth edition of the melanoma staging manual, mitotic activity in T1 melanomas has also been associated with an increased risk of SLN metastasis . In this series, the analysis was performed on those, only with complete data.…”

Section: Discussionmentioning

confidence: 99%

Subungual melanoma: A retrospective cohort of 157 cases from Brazilian National Cancer Institute

Nunes

Mendes

Koifman

2018

Journal of Surgical Oncology

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Background Subungual melanoma (SM) is rare. The lesions are thick at the time of diagnosis. Few studies have evaluated SM in Brazil. Objective The objective of this study was to investigate the factors associated with the survival of SM patients from the Brazilian National Cancer Institute. Methods One‐hundred and fifty‐seven patients diagnosed with SM were included in this study. We evaluated the epidemiologic, clinical, and histopathological data. Overall survival (OS) and relapse‐free survival (RFS) curves were computed using the Kaplan‐Meier method. Multivariable analyses were conducted using the Cox proportional hazard regression model. Results Among the 157 patients, 87 (55.4%) were female. The median age was 68 years old. Median tumor depth was 6.0 mm. Lesions were ulcerated in 94 (59.9%). OS and RFS rates for 5 years were 61.0% and 41.8%, respectively. Median follow‐up time was 28 months. The factors associated with OS were Breslow thickness and ulceration, and for RFS, they were the anatomical site, Breslow thickness, and ulceration. Conclusion This is the largest series of SM patients. The 5‐year OS and RFS rates were low (61.0% and 48.2%, respectively), and the main prognostic factors for OS were Breslow thickness and ulceration.

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“…The mitotic rate will likely be an important parameter for inclusion in the future development of prognostic models applicable to individual patients. Although it is not included in the T1 subcategory criteria, mitotic activity in T1 melanomas also has been associated with an increased risk of SLN metastasis …”

Section: Major Changesmentioning

confidence: 99%

“…Overall, SLN metastases are very infrequent (<5%) in melanomas <0.8 mm in thickness but occur in approximately 5% to 12% of patients with primary melanomas from 0.8 to 1.0 mm in thickness, [43][44][45][46] and consensus guidelines have recommended that SLN biopsy be considered in this latter group of patients, particularly when other adverse prognostic parameters are also present. [47][48][49][50] As in the seventh edition, patients with primary melanoma and no evidence of regional or distant metastasis are stratified into 8 T subcategories (T1a through T4b). MSS stratified by T subcategory for 23,001 patients with complete covariate data is illustrated in Figure 1.…”

Section: Definition Of Primary Tumor (T)mentioning

confidence: 99%

Melanoma staging: Evidence‐based changes in the American Joint Committee on Cancer eighth edition cancer staging manual

Gershenwald

Scolyer

Hess

et al. 2017

CA A Cancer J Clinicians

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1,704

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To update the melanoma staging system of the American Joint Committee on Cancer (AJCC) a large database was assembled comprising >46,000 patients from 10 centers worldwide with stages I, II, and III melanoma diagnosed since 1998. Based on analyses of this new database, the existing seventh edition AJCC stage IV database, and contemporary clinical trial data, the AJCC Melanoma Expert Panel introduced several important changes to the Tumor, Nodes, Metastasis (TNM) classification and stage grouping criteria. Key changes in the eighth edition AJCC Cancer Staging Manual include: 1) tumor thickness measurements to be recorded to the nearest 0.1 mm, not 0.01 mm; 2) definitions of T1a and T1b are revised (T1a, <0.8 mm without ulceration; T1b, 0.8–1.0 mm with or without ulceration or <0.8 mm with ulceration), with mitotic rate no longer a T category criterion; 3) pathological (but not clinical) stage IA is revised to include T1b N0 M0 (formerly pathologic stage IB); 4) the N category descriptors “microscopic” and “macroscopic” for regional node metastasis are redefined as “clinically occult” and “clinically apparent”; 5) prognostic stage III groupings are based on N category criteria and T category criteria (ie, primary tumor thickness and ulceration) and increased from 3 to 4 subgroups (stages IIIA–IIID); 6) definitions of N subcategories are revised, with the presence of microsatellites, satellites, or in-transit metastases now categorized as N1c, N2c, or N3c based on the number of tumor-involved regional lymph nodes, if any; 7) descriptors are added to each M1 subcategory designation for lactate dehydrogenase (LDH) level (LDH elevation no longer upstages to M1c); and 8) a new M1d designation is added for central nervous system metastases. This evidence-based revision of the AJCC melanoma staging system will guide patient treatment, provide better prognostic estimates, and refine stratification of patients entering clinical trials.

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Mitotic rate correlates with sentinel lymph node status and outcome in cutaneous melanoma greater than 1 millimeter in thickness: A multi-institutional study of 1524 cases

Cited by 40 publications

References 18 publications

Clinical impact of ulceration width, lymphovascular invasion, microscopic satellitosis, perineural invasion, and mitotic rate in patients undergoing sentinel lymph node biopsy for cutaneous melanoma: a retrospective observational study at a comprehensive cancer center

Clinical impact of ulceration width, lymphovascular invasion, microscopic satellitosis, perineural invasion, and mitotic rate in patients undergoing sentinel lymph node biopsy for cutaneous melanoma: a retrospective observational study at a comprehensive cancer center

Subungual melanoma: A retrospective cohort of 157 cases from Brazilian National Cancer Institute

Melanoma staging: Evidence‐based changes in the American Joint Committee on Cancer eighth edition cancer staging manual

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