Sentinel Lymph Node Biopsy for Recurrent Melanoma: A Multicenter Study

Beasley, Georgia M.; Hu, Yinin; Youngwirth, Linda M.; Scheri, Randall P.; Salama, April K.S.; Rossfeld, Kara; Gardezi, Syed; Agnese, Doreen M.; Howard, John H.; Tyler, Douglas S.; Slingluff, Craig L.; Terando, Alicia M.

doi:10.1245/s10434-017-5883-6

Cited by 28 publications

(22 citation statements)

References 29 publications

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“…An additional consideration for the surgeon is to perform SLNB for an in‐transit or satellite lesion given our group has reported a 40% rate of SLNB positivity in those patients . At the time of that publication, the only adjuvant therapy approval was for ipilimumab which required 1 mm of SLNB involvement.…”

Section: Applying Trial Results To Clinical Practicementioning

confidence: 99%

Updates in adjuvant systemic therapy for melanoma

Kwak

Farrow

Salama

et al. 2018

Journal of Surgical Oncology

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There has been a rapid increase in adjuvant therapies approved for treatment following surgical resection of stage III/IV melanoma. We review current indications for adjuvant therapy, which currently includes a heterogenous group of Stage III and IV melanoma patients. We describe several pivotal clinical trials of systemic immune therapies, targeted immune therapies, and adjuvant vaccine strategies. Finally, we discuss the evidence for selecting the most appropriate treatment regimen(s) for the individual patient.

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Section: Applying Trial Results To Clinical Practicementioning

confidence: 99%

Updates in adjuvant systemic therapy for melanoma

Kwak

Farrow

Salama

et al. 2018

Journal of Surgical Oncology

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“…Thus, in one recent study of patients who developed limited local resectable recurrence between 2005 and 2014, only 31% developed distant metastasis while 29% died of melanoma during the follow-up period (40). This finding has been reproduced in several other studies (41,42). This is not dissimilar from the death rate from stage III primary melanoma (40).…”

Section: Discussionmentioning

confidence: 67%

Validation of Melanoma Immune Profile (MIP), a Prognostic Immune Gene Prediction Score for Stage II–III Melanoma

Gartrell

Marks

Rizk

et al. 2019

Clinical Cancer Research

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Purpose: Biomarkers are needed to stratify patients with stage II-III melanoma for clinical trials of adjuvant therapy because, while immunotherapy is protective, it also confers the risk of severe toxicity. We previously defined and validated a 53-immune gene melanoma immune profile (MIP) predictive both of distant metastatic recurrence and of disease-specific survival (DSS). Here, we test MIP on a third independent population.Experimental Design: A retrospective cohort of 78 patients with stage II-III primary melanoma was analyzed using the NanoString assay to measure expression of 53 target genes, and MIP score was calculated. Statistical analysis correlating MIP with DSS, overall survival, distant metastatic recurrence, and distant metastasis-free interval was performed using ROC curves, Kaplan-Meier curves, and standard univariable and multivariable Cox proportional hazards models.Results: MIP significantly distinguished patients with distant metastatic recurrence from those without distant metastatic recurrence using ROC curve analysis (AUC ¼ 0.695; P ¼ 0.008). We defined high-and low-risk groups based on the cutoff defined by this ROC curve and find that MIP correlates with both DSS and overall survival by ROC curve analysis (AUC ¼ 0.719; P ¼ 0.004 and AUC ¼ 0.698; P ¼ 0.004, respectively). Univariable Cox regression reveals that a highrisk MIP score correlates with DSS (P ¼ 0.015; HR ¼ 3.2).Conclusions: MIP identifies patients with low risk of death from melanoma and may constitute a clinical tool to stratify patients with stage II-III melanoma for enrollment in clinical trials. Analysis and interpretation of data (e.g., statistical analysis, biostatistics, computational analysis): Figure 4. MIP correlates with DMFI and DSS using Cox regression analysis. A, Univariable and multivariable Cox analysis of DMFI. B, Univariable and multivariable Cox analysis of DSS. Values are significant at P 0.05 ( Ã , P 0.05; ÃÃ , P 0.01; ÃÃÃ , P 0.001).Gartrell et al.

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“…The median DMFS was 23 months for those staged node negative by clinical examination only, and 5 months for those with synchronous macroscopic nodal disease . A recent review of three institutions experience found similar findings; progression free survival of 6 years in the SLN negative group and 1.4 years in the SLN positive group and OS of 83% and 57%, respectively ( P = 0.06) …”

Section: Introductionmentioning

confidence: 67%

“…For the bulk of patients who are clinically node negative, micrometastasis can be identified in the regional lymph nodes in approximately 30% to 50% of patients. A recent review of four series, including 203 patients undergoing SLNB for IT disease reported a positive SLN in 39% and 36% had additional positive lymph nodes at completion lymph node dissection . Although IT disease alone is adequate to consider systemic therapy, for the clinically node‐negative patients, SLNB can further stratify patients into two fairly distinct prognostic groups (N1 vs N2 or N3 disease) which could have an impact on the decision for adjuvant systemic therapy.…”

Section: Introductionmentioning

confidence: 99%

Management of local or regional non‐nodal disease

Racz

Block

Baum

et al. 2018

Journal of Surgical Oncology

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Some melanomas develop a striking avidity for lymphatic spread. In spite of multiple recurrences, patients can remain years without visceral metastasis. There is clearly a biologic reason for this lymphotrophic pattern of growth and dissemination, which we have yet to uncover. In-transit metastases have widely diverse clinical presentations and can be a stubborn disease to cure. As a result, a host of treatments exist that should be tailored to the individual patient. K E Y W O R D S diphenylcyclopropenone, in transit, intralesional therapy, limb perfusion, melanoma, stage III, talimogene laherparepvec 1 | INTRODUCTION Non-nodal locoregional metastasis in the setting of melanoma includes microsatellites, satellites, and in-transit metastasis (ITM). This pattern of spread is primarily the result of dermal and subcutaneous intralymphatic contamination. The presence of melanoma cells within this rich lymphatic plexus can result in recurrent disease anywhere from the primary site to the regional nodal basin and rarely retrograde, distal to the primary lesion. Historically, microsatellites were defined as microscopic foci identified on pathologic analysis, adjacent or deep to the primary. Clinically detected cutaneous and/or subcutaneous locoregional metastases were arbitrarily categorized based on their proximity to the primary melanoma; satellite lesions occurring within 2 cm of the primary and ITM lesions >2 cm from the melanoma. All these disease patterns have similar prognoses and the 8th edition of The American Joint Committee on Cancer Staging System has added clarity to this issue. 1The updated edition categorizes all regional nodal and intralymphatic disease as N1-N3 disease. Additionally, number of lesions differentiates N1-N3 and the subcategories a-c are distinguished based on clinically occult, clinically detected, matted and/or intralymphatic disease. One should make a distinction, when possible, between a true local recurrence, which represents subclinical persistent primary tumor after initial management; often in the setting of inadequate management such as incomplete resection, as opposed to intralymphatic disease. A true local recurrence portends a better prognosis than cutaneous metastases. 2 The distinction between distant skin, subcutaneous or lymph node metastasis is even more important as these are categorized as M1a, stage IV disease.In-transit metastases occur in 5% to 10% of patients with intermediate thickness melanoma [3][4][5][6][7] and have a propensity for the lower extremities. 8,9 In-transit metastasis often appear indolent and easily treatable, particularly when few in number. However, due to the aforementioned concept of lymphatic contamination, recurrence remains the rule and not the exception especially when management consists of targeted treatment of individual lesions rather than a more holistic approach that addresses the involved lymphatic network and nodal basin. Before embarking on treatment of new ITM, we obtain systemic imaging, PET scan preferred, to rule out clinically ...

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Sentinel Lymph Node Biopsy for Recurrent Melanoma: A Multicenter Study

Abstract: SLNB can be successful in patients with LR/IT melanoma, even if prior SLNB was performed. In this population, the rates of SLNB positivity and nonsentinel node metastases were 40% and 37%, respectively. SLNB may guide management and prognosis after LR/IT disease.

Cited by 28 publications

References 29 publications

Updates in adjuvant systemic therapy for melanoma

Updates in adjuvant systemic therapy for melanoma

Validation of Melanoma Immune Profile (MIP), a Prognostic Immune Gene Prediction Score for Stage II–III Melanoma

Management of local or regional non‐nodal disease

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