Predictors of sentinel lymph node positivity in thin melanoma using the National Cancer Database

Conic, Rosalynn R.Z.; Ko, Jennifer S.; Damiani, Giovanni; Funchain, Pauline; Knackstedt, Thomas; Vij, Alok; Vidimos, Allison; Gastman, Brian

doi:10.1016/j.jaad.2018.08.051

Cited by 39 publications

(45 citation statements)

References 35 publications

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“…This is no surprising finding, as it is known that ulceration is a negative prognostic factor and associated with higher BT as well, both of which is known to increase the likelihood of a positive SLNB. 25,26 No significant difference in OS was found between patients with only INN and patients with negative SLNB, corroborating previous studies, 12,13 while patients with positive SLNB had significantly worse OS as expected. However, patients with INN in our study were significantly younger compared with patients with negative and positive SLNB, which may have affected OS.…”

Section: Discussionsupporting

confidence: 88%

“…Regarding ulceration, we found a nearly similar ulceration rate between INN‐ and SLNB‐negative patients (respectively 19.2% and 20.3%), compared with 35.1% in SLNB‐positive patients ( P < 0.001). This is no surprising finding, as it is known that ulceration is a negative prognostic factor and associated with higher BT as well, both of which is known to increase the likelihood of a positive SLNB …”

Section: Discussionmentioning

confidence: 62%

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Intra‐nodal nevi in sentinel node‐negative patients with cutaneous melanoma does not influence survival

Beer

Diest

Sigurdsson

et al. 2019

Acad Dermatol Venereol

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Background Melanoma patients with intra‐nodal nevi (INN) and without melanoma metastasis in the sentinel lymph node biopsy (SLNB) are generally treated as patients with negative SLNB. However, diagnosis of INN may be difficult and nodal melanoma metastases may falsely be regarded as INN. Objectives Our aim was to evaluate the clinical significance of INN in the SLNB in patients with primary cutaneous melanoma on a nationwide level in The Netherlands by comparing survival between three groups: patients with INN and without nodal melanoma metastasis (INN group), patients without INN and without nodal melanoma metastasis (negative SLNB group) and patients with nodal melanoma metastasis irrespective of INN (positive SLNB group). Methods Data were obtained from ‘PALGA’, the Dutch Nationwide Network and Registry of Histopathology and Cytopathology, yielding a cohort of adults with histologically proven, primary, invasive cutaneous melanoma patients in The Netherlands diagnosed between 2000 and 2014 who underwent SLNB. Clinical and pathological variables were extracted from the pathology text files. Differences between patients with INN, negative SLNB and positive SLNB were analysed using Kaplan–Meier analysis. Results A total of 11 274 patients were eligible for inclusion. The prevalence of INN in the SLNB was 5.0%. Melanomas with INN had similar median Breslow thickness compared to melanomas with negative SLNB and were more frequently located on trunk and upper limbs and observed in younger patients compared to melanomas with negative and positive SLNB. Overall survival of patients with INN showed no significant difference compared with negative SLNB (median follow‐up of 5.7 years of all patients). Conclusions As there seems to be no difference in overall survival between patients with INN and negative SLNB, the diagnosis of INN seems to be reliable. Current practice to treat patients with INN as patients with negative SLNB appears to be appropriate.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 62%

Intra‐nodal nevi in sentinel node‐negative patients with cutaneous melanoma does not influence survival

Beer

Diest

Sigurdsson

et al. 2019

Acad Dermatol Venereol

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“…7 Because of frequent regional LN involvement, sentinel lymph node biopsy (SLNB) is generally recommended for patients with clinically localized MCC, although a survival benefit has not been clearly demonstrated. [7][8][9][10][11] Distant metastasis also occurs frequently; institutional series demonstrate that approximately one-third of patients with MCC will eventually develop distant disease. 12,13 However, because of the relative infrequency of this disease, the timing and frequencies of regional and distant disease spread have not been well characterized, resulting in relatively vague baseline and surveillance imaging recommendations.…”

Section: Discussionmentioning

confidence: 99%

“…The SLN positivity rate was 25%, consistent with the range reported in the literature for MCC (23-45%) and comparable to that for thick melanoma (26-33%), for which SLNB is typically recommended. 8,10,11,[16][17][18][19][20][21][22][23][24][25][26][27] Frequent regional LN surveillance following initial MCC treatment also should be prioritized. The false-negative rate for SLNB was relatively high at 22% in the present study and in the range of 15-21% in the literature.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Metastasis in Merkel Cell Carcinoma

et al. 2020

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Background. Merkel cell carcinoma (MCC) is a cutaneous neuroendocrine malignancy with a propensity for regional and distant spread. Because of the relative infrequency of this disease, the patterns of metastasis in MCC are understudied. Methods. Patients with American Joint Committee on Cancer (8th edition) stage I-IV MCC treated at our institution were identified (1/1/2008-2/28/2018). The first site of metastasis was classified as regional [regional lymph node (LN) basin, in-transit] or distant. Distant metastasisfree (DMFS) and MCC-specific (MSS) survival were estimated. Results. Of 133 patients, 64 (48%) had stage I, 13 (10%) stage II, 48 (36%) stage III, and 8 (6%) stage IV disease at presentation. The median follow-up time in patients who remained alive was 36 (interquartile range 20-66) months. Regional or distant metastases developed in 78 (59%) patients. The first site was regional in 87%, including 73% with isolated LN involvement, and distant in 13%. Thirtyseven (28%) patients eventually developed distant disease, which most commonly involved the abdominal viscera (51%) and distant LNs (46%) first. The lung (0%) and brain (3%) were rarely the first distant sites. Stage III MCC at presentation was significantly associated with worse DMFS (hazard ratio 4.87, P = 0.001) and stage IV disease with worse MSS (hazard ratio 6.30, P = 0.002).

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“…Accordingly, SLNB should be considered for patients with thin melanomas with a BT ≥0.8 mm or with ulceration, and for patients with thinner melanomas with other adverse features (mitotic rate [MR] ≥2/mm 2 , lymphovascular invasion [LVI], and/or younger age) . In addition to these adverse features, others such as Clark level, regression, and vertical growth phase have been shown to be associated with +SLN in patients with thin melanoma . However, it is unknown whether a combination of these risk factors could identify a group of patients at higher risk of a +SLN for which a SLNB could be justified, and consequently, accurate selection of patients in this population for SLNB remains a challenge …”

Section: Introductionmentioning

confidence: 99%

A nomogram to predict node positivity in patients with thin melanomas helps inform shared patient decision making

Friedman¹,

Lyon²,

Torphy³

et al. 2019

Journal of Surgical Oncology

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Objective: To develop a nomogram to estimate the probability of positive sentinel lymph node (+SLN) for patients with thin melanoma and to characterize its potential impact on sentinel lymph node biopsy (SLNB) rates.Methods: Patients diagnosed with thin (0.5-1.0 mm) melanoma were identified from the National Cancer Database 2012 to 2015. A multivariable logistic regression model was used to examine factors associated with +SLN, and a nomogram to predict +SLN was constructed. Nomogram performance was evaluated and diagnostic test statistics were calculated.Results: Of the 21 971 patients included 10 108 (46.0%) underwent SLNB, with a 4.0% +SLN rate. On multivariable analysis, age, Breslow thickness, lymphovascular invasion, ulceration, and Clark level were significantly associated with SLN status. The area under the receiver operating curve was 0.67 (95% confidence interval, 0.65-0.70). While 15 249 (69.4%) patients had either T1b tumors or T1a tumors with at least one adverse feature, only 2846 (13.0%) had a nomogram predicted probability of a +SLN ≥5%. Using this cutoff, the indication for a SLNB in these patients would be reduced by 81.3% as compared to the American Joint Committee on Cancer 8th edition staging criteria. Conclusions:The risk predictions obtained from the nomogram allow for more accurate selection of patients who could benefit from SLNB.

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Predictors of sentinel lymph node positivity in thin melanoma using the National Cancer Database

Cited by 39 publications

References 35 publications

Intra‐nodal nevi in sentinel node‐negative patients with cutaneous melanoma does not influence survival

Intra‐nodal nevi in sentinel node‐negative patients with cutaneous melanoma does not influence survival

Patterns of Metastasis in Merkel Cell Carcinoma

A nomogram to predict node positivity in patients with thin melanomas helps inform shared patient decision making

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