Sentinel lymph node biopsy in patients with T1a cutaneous malignant melanoma: A multicenter cohort study

Shannon, Adrienne B.; Sharon, Cimarron E.; Straker, Richard J.; Carr, Michael J.; Sinnamon, Andrew J.; Bogatch, Kita; Thaler, Alexandra S; Kelly, Nicholas J; Vetto, John T.; Fowler, Graham; DePalo, Danielle; Sondak, Vernon K.; Miura, John T.; Faries, Mark B.; Bartlett, Edmund K.; Zager, Jonathan S.; Karakousis, Giorgos C.

doi:10.1016/j.jaad.2022.09.040

Cited by 13 publications

(8 citation statements)

References 31 publications

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“…Such a patient has a 15 year melanoma-specific mortality prediction (MSMP) of 3%, yet the SLNB-positivity risk is about 12% [ 58 ]. Shannon et al suggest SLNB should be considered because the SLNB risk of being positive is high [ 59 ].…”

Section: Slnb and Agementioning

confidence: 99%

Primary Cutaneous Melanoma—Management in 2024

Dixon,

Sladden,

Zouboulis

et al. 2024

JCM

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Background: Maximizing survival for patients with primary cutaneous melanomas (melanomas) depends on an early diagnosis and appropriate management. Several new drugs have been shown to improve survival in high-risk melanoma patients. Despite well-documented guidelines, many patients do not receive optimal management, particularly when considering patient age. Objective: to provide an update on melanoma management from the time of the decision to biopsy a suspicious skin lesion. Methods: We reviewed melanoma-management research published between 2018 and 2023 and identified where such findings impact and update the management of confirmed melanomas. Pubmed, Google Scholar, Ovid and Cochrane Library were used as search tools. Results: We identified 81 publications since 2017 that have changed melanoma management; 11 in 2018, 12 in 2019, 10 in 2020, 12 in 2021, 17 in 2022 and 18 in 2023. Discussion: Delayed or inaccurate diagnosis is more likely to occur when a partial shave or punch biopsy is used to obtain the histopathology. Wherever feasible, a local excision with a narrow margin should be the biopsy method of choice for a suspected melanoma. The Breslow thickness of the melanoma remains the single most important predictor of outcome, followed by patient age and then ulceration. The BAUSSS biomarker, (Breslow thickness, Age, Ulceration, Subtype, Sex and Site) provides a more accurate method of determining mortality risk than older currently employed approaches, including sentinel lymph node biopsy. Patients with metastatic melanomas and/or nodal disease should be considered for adjuvant drug therapy (ADT). Further, high-risk melanoma patients are increasingly considered for ADT, even without disease spread. Invasive melanomas less than 1 mm thick are usually managed with a radial excision margin of 10 mms of normal skin. If the thickness is 1 to 2 mm, select a radial margin of 10 to 20 mm. When the Breslow thickness is over 2 mm, a 20 mm clinical margin is usually undertaken. In situ melanomas are usually managed with a 5 to 10 mm margin or Mohs margin control surgery. Such wide excisions around a given melanoma is the only surgery that can be regarded as therapeutic and required. Patients who have had one melanoma are at increased risk of another melanoma. Ideal ongoing management includes regular lifelong skin checks. Total body photography should be considered if the patient has many naevi, especially when atypical/dysplastic naevi are identified. Targeted approaches to improve occupational or lifestyle exposure to ultraviolet light are important. Management also needs to include the consideration of vitamin D supplementary therapy.

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Section: Slnb and Agementioning

confidence: 99%

Primary Cutaneous Melanoma—Management in 2024

Dixon,

Sladden,

Zouboulis

et al. 2024

JCM

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“…SLNB is generally recommended for patients with a TT of ≥0.8 mm because the probability of harboring positive SLNs in patients with a TT of <0.8 mm without ulceration (T1a disease) is extremely low (<5%). 58 Additionally, a recent retrospective study 59 (n = 77) received CLND plus adjuvant therapies. 63 Another retrospective study 64 from Japan also demonstrated that the proportion of patients with positive SLN who underwent CLND was significantly lower after the publication of the MSLT-II trial results and approval of novel adjuvant therapies (66.1% [37/56] vs 90.5%…”

Section: Target Patients For Slnbmentioning

confidence: 99%

“…SLNB is generally recommended for patients with a TT of ≥0.8 mm because the probability of harboring positive SLNs in patients with a TT of <0.8 mm without ulceration (T1a disease) is extremely low (<5%) 58 . Additionally, a recent retrospective study 59 in patients with T1a disease demonstrated that significant high‐risk factors for positive SLN are associated with age ≤42 years (7.5%), head/neck primary tumor (9.2%), lymphovascular invasion (21.4%), and ≥2 mitoses/mm 2 (8.2%). When patients had two factors of age <42 years and ≥2 mitoses/mm 2 , the rate of positive SLN was 18.4% 59 …”

Section: Sln Biopsymentioning

confidence: 99%

“…Additionally, a recent retrospective study 59 in patients with T1a disease demonstrated that significant high‐risk factors for positive SLN are associated with age ≤42 years (7.5%), head/neck primary tumor (9.2%), lymphovascular invasion (21.4%), and ≥2 mitoses/mm 2 (8.2%). When patients had two factors of age <42 years and ≥2 mitoses/mm 2 , the rate of positive SLN was 18.4% 59 …”

Section: Sln Biopsymentioning

confidence: 99%

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Current surgical management for melanoma

Koizumi,

Inozume,

Nakamura

2023

The Journal of Dermatology

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Melanoma is a major malignant cutaneous neoplasm with a high mortality rate. In recent years, the treatment of melanoma has developed dramatically with the invention of new therapeutic agents, including immune checkpoint inhibitors and molecular‐targeted agents. These agents are available as adjuvant therapies for postoperative patients with stage IIB, IIC, and III melanomas. Furthermore, neoadjuvant therapy has been studied in several global clinical trials and has demonstrated promising and favorable clinical efficacy, mainly in patients with palpable regional lymph nodes. A recent large phase III clinical trial investigating early lymph node dissection for sentinel lymph node metastases demonstrated no survival benefits. Based on these data, surgery should be reconsidered as an appropriate treatment modality for melanoma. The need for invasive surgical procedures will be reduced with the invention of effective adjuvant and neoadjuvant therapies and novel clinical trial data on regional lymph node dissection. However, surgery still plays an important role in treating early‐stage melanoma, accurately determining the disease stage, and effective palliative treatment for advanced melanoma. In this article, we focus on surgery for primary tumors, regional lymph nodes, and metastatic sites in an era of remarkably revolutionary drug treatments for melanoma.

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“…Huang et al conducted a meta-analysis evaluating positivity of SLNB results in thin melanoma and found that features that significantly predicted a positive SLNB result included thickness ≥ 0.8 mm (positive rate, 7.0%), presence of ulceration (positive rate, 4.2%), and mitotic index > 0/mm 2 (positive rate, 7.7%) [ 42 ]. In another retrospective study analyzing the outcomes of patients with pathologic T1a (thickness < 0.8 mm, nonulcerated) who underwent SLNB, factors significantly associated with positive SLNB results were age ≤ 42 years (positive rate, 7.5%), head/neck primary tumor location (positive rate, 9.2%), lymphovascular invasion (positive rate, 21.4%), and mitotic index ≥ 2/mm 2 (positive rate, 8.2%) [ 43 ]. These reported factors associated with an increased rate of positive SLNB results may be useful to determine which patients with thin melanoma should undergo SLNB and are summarized in Table 1 .…”

Section: Role Of Slnb In Skin Cancermentioning

confidence: 99%

Role of Sentinel Lymph Node Biopsy for Skin Cancer Based on Clinical Studies

Ishizuki

Nakamura

2023

Cancers

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The sentinel lymph node is the first lymph node from the primary tumor. Sentinel lymph node biopsy (SLNB) is a surgical procedure that can detect occult nodal metastasis with relatively low morbidity. It may also have a therapeutic effect via regional disease control. The Multicenter Selective Lymphadenectomy-I (MSLT-I) trial revealed a prognostic benefit from SLNB in melanoma patients. However, it remains unclear whether there is a prognostic benefit from SLNB in patients with nonmelanoma skin cancer owing to a lack of randomized prospective studies. Nevertheless, SLNB provides important information about nodal status, which is one of the strongest factors to predict prognosis and may guide additional nodal treatment. Currently, SLNB is widely used in the management of not only patients with melanoma but also those with nonmelanoma skin cancer. However, the utilization and outcomes of SLNB differ among skin cancers. In addition, SLNB is not recommended for routine use in all patients with skin cancer. In this review, we provide a summary of the role of SLNB and of the indications for SLNB in each skin cancer based on previously published articles.

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Sentinel lymph node biopsy in patients with T1a cutaneous malignant melanoma: A multicenter cohort study

Cited by 13 publications

References 31 publications

Primary Cutaneous Melanoma—Management in 2024

Primary Cutaneous Melanoma—Management in 2024

Current surgical management for melanoma

Role of Sentinel Lymph Node Biopsy for Skin Cancer Based on Clinical Studies

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