Sentinel Lymph Node Biopsy in Patients With Thin Primary Cutaneous Melanoma

Abstract

There is a low but significant rate of SLN positivity in patients with primary melanomas 0.51 to 1.0 mm in thickness. Given its prognostic importance, SLNB should be considered in such patients, particularly if there is lymphatic permeation by melanoma at the primary tumor site. More frequent regional node field recurrences in patients with head/neck primary tumors may be a consequence of complex lymphatic drainage patterns in this region.

How staging of thin melanoma is changed after the introduction of TNM 7th edition: a population-based analysis

“…In our data, sentinel node metastasis was found in only six (2.4 %) patients with thin melanomas, with a rate of sentinel node positivity lower than rates recently reported in the literature (Mozzillo et al 2013;Murali et al 2012).…”

Melanoma Staging: American Joint Committee on Cancer (AJCC) 8th Edition and Beyond

“…Overall, SLN metastases are very infrequent (\ 5%) in patients whose melanoma is \ 0.8 mm in thickness and nonulcerated (i.e., AJCC 8th edition T1a) but occur in approximately 5-12% of patients with primary melanomas 0.8-1.0 mm in thickness (i.e., AJCC 8th edition T1b). [14][15][16][17] Reflective of these data, consensus guidelines have recommended that SLN biopsy may be considered in this latter group of patients (i.e., patients with a primary tumor thickness 0.8-1.0 mm) and also in patients with thinner ulcerated tumors (i.e., all patients with AJCC 8th edition T1b melanomas). 18,19 Although mitosis was removed as a T1 subcategory criterion, analyses performed for both the 7th and 8th edition AJCC staging systems demonstrated that tumor mitotic rate, when explored across its dynamic range, was a very important prognostic factor and strongly supports that if interrogated in this fashion, will likely be an important covariate going forward as clinical tools are developed.…”

Prediction of Survival in Patients With Thin Melanoma: Results From a Multi-Institution Study

“…They found that patients younger than age 35 years with tumors less than 1 mm had a substantial risk of a positive SN, particularly if MR was high. Murali et al 19 also found that LVI was associated with SN positivity in melanomas Յ 1.0 mm and concluded that SNB should be considered in patients with lymphatic permeation of melanoma at the primary site.…”