Sentinel node biopsy status is strongly predictive of survival in cutaneous melanoma: Extended follow-up of Oxford patients from 1998 to 2014

Thomson, David R.; Rughani, Milap G.; Kuo, Rachel; Cassell, Oliver

doi:10.1016/j.bjps.2017.05.025

Cited by 15 publications

(14 citation statements)

References 20 publications

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“…Regarding the subgroup who underwent SLNB, we found that a positive status of SLN significantly predicted a worse MSS outcome, which is consistent with previous reports on AM and cutaneous melanoma. 10,25,26 There are some limitations and strengths in our study. First, only a small proportion of AM patients underwent SLNB in this retrospective study.…”

Section: Discussionmentioning

confidence: 98%

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The Clinicopathological and Survival Profiles Comparison Across Primary Sites in Acral Melanoma

Wei

et al. 2020

Ann Surg Oncol

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Background. The clinicopathological and survival profiles across primary sites in acral melanoma (AM) are still controversial and unclear. Methods. This is a multi-center retrospective study. Clinicopathological data of AM patients diagnosed between 1 January 2000 and 31 December 2017 from 6 large tertiary hospitals in China were extracted. Chi square tests were used to compare basic characteristics between primary sites of sole, palm and nail bed. Melanomaspecific survival (MSS) differences based on primary sites were compared by log-rank tests and multivariate Cox regressions were used to identify prognostic factors for MSS. Results. In total, 1157 AM patients were included. The sole group had a more advanced initial stage, deeper Breslow thickness, higher recurrence rate and distant metastases risk (all P \ 0.05). The proportion of age \ 65 years and ulceration were statistically lower in nail bed and palm groups, respectively. A total of 294 patients underwent sentinel lymph node biopsy and rates of positive SLN status had no statistical difference across primary sites. Among 701 patients with genetic profiles, the mutational frequency of BRAF, C-KIT, and PDGFRA were similar except for NRAS (higher in sole group, P = 0.0102). The median MSS of sole, nail bed and palm patients were 65.0 months, 112.0 months, and not reached, respectively (log-rank P = 0.0053). In multivariate analyses, primary site, initial stage, ulceration and recurrence were the prognostic factors for MSS in overall population, but the statistical significance varied over primary sites. Conclusions. Substantial clinicopathological and survival heterogeneities exist across different primary sites in the AM population. Sole melanoma has worse prognosis compared with palm and nail bed subtypes. Melanoma is a malignancy with a steadily increasing incidence worldwide. Acral melanoma (AM) is a term referring to the melanoma affecting soles, palms, and nail beds. 1 It is documented as the least common subtype in Caucasians but constitutes up to 50-75% in populations of color. 2-5

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

The Clinicopathological and Survival Profiles Comparison Across Primary Sites in Acral Melanoma

Wei

et al. 2020

Ann Surg Oncol

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“…The first evidence of its routine use in some of the larger melanoma centres in the UK, as well as in routine practice in the USA, was around 2000. 100 We, therefore, limited the subsidiary search criteria to this date.…”

Section: Search Strategymentioning

confidence: 99%

“…Following deduplication, publications were limited from 1998 to July 2019, as this is when SLNB became clinically utilised as a prognostic indicator. 100 A grey literature and guidelines search was conducted to identify further relevant material not retrieved by the database searches (Box 6). A range of guidelines on melanoma from a range of countries were also identified, and the evidence supporting relevant recommendations relating to the diagnosis of recurrent disease was checked.…”

Section: Search Strategymentioning

confidence: 99%

Optimal surveillance strategies for patients with stage 1 cutaneous melanoma post primary tumour excision: three systematic reviews and an economic model

Vale

Kunonga

Coughlan

et al. 2021

Health Technol Assess

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Background Malignant melanoma is the fifth most common cancer in the UK, with rates continuing to rise, resulting in considerable burden to patients and the NHS. Objectives The objectives were to evaluate the effectiveness and cost-effectiveness of current and alternative follow-up strategies for stage IA and IB melanoma. Review methods Three systematic reviews were conducted. (1) The effectiveness of surveillance strategies. Outcomes were detection of new primaries, recurrences, metastases and survival. Risk of bias was assessed using the Cochrane Collaboration’s Risk-of-Bias 2.0 tool. (2) Prediction models to stratify by risk of recurrence, metastases and survival. Model performance was assessed by study-reported measures of discrimination (e.g. D-statistic, Harrel’s c-statistic), calibration (e.g. the Hosmer–Lemeshow ‘goodness-of-fit’ test) or overall performance (e.g. Brier score, R 2). Risk of bias was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). (3) Diagnostic test accuracy of fine-needle biopsy and ultrasonography. Outcomes were detection of new primaries, recurrences, metastases and overall survival. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies–2 (QUADAS–2) tool. Review data and data from elsewhere were used to model the cost-effectiveness of alternative surveillance strategies and the value of further research. Results (1) The surveillance review included one randomised controlled trial. There was no evidence of a difference in new primary or recurrence detected (risk ratio 0.75, 95% confidence interval 0.43 to 1.31). Risk of bias was considered to be of some concern. Certainty of the evidence was low. (2) Eleven risk prediction models were identified. Discrimination measures were reported for six models, with the area under the operating curve ranging from 0.59 to 0.88. Three models reported calibration measures, with coefficients of ≥ 0.88. Overall performance was reported by two models. In one, the Brier score was slightly better than the American Joint Committee on Cancer scheme score. The other reported an R 2 of 0.47 (95% confidence interval 0.45 to 0.49). All studies were judged to have a high risk of bias. (3) The diagnostic test accuracy review identified two studies. One study considered fine-needle biopsy and the other considered ultrasonography. The sensitivity and specificity for fine-needle biopsy were 0.94 (95% confidence interval 0.90 to 0.97) and 0.95 (95% confidence interval 0.90 to 0.97), respectively. For ultrasonography, sensitivity and specificity were 1.00 (95% confidence interval 0.03 to 1.00) and 0.99 (95% confidence interval 0.96 to 0.99), respectively. For the reference standards and flow and timing domains, the risk of bias was rated as being high for both studies. The cost-effectiveness results suggest that, over a lifetime, less intensive surveillance than recommended by the National Institute for Health and Care Excellence might be worthwhile. There was considerable uncertainty. Improving the diagnostic performance of cancer nurse specialists and introducing a risk prediction tool could be promising. Further research on transition probabilities between different stages of melanoma and on improving diagnostic accuracy would be of most value. Limitations Overall, few data of limited quality were available, and these related to earlier versions of the American Joint Committee on Cancer staging. Consequently, there was considerable uncertainty in the economic evaluation. Conclusions Despite adoption of rigorous methods, too few data are available to justify changes to the National Institute for Health and Care Excellence recommendations on surveillance. However, alternative strategies warrant further research, specifically on improving estimates of incidence, progression of recurrent disease; diagnostic accuracy and health-related quality of life; developing and evaluating risk stratification tools; and understanding patient preferences. Study registration This study is registered as PROSPERO CRD42018086784. Funding This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol 25, No. 64. See the NIHR Journals Library website for further project information.

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“…This minimally invasive procedure has successfully replaced elective lymph node dissection in the management of melanoma patients [28,29]. According to several studies, histological features of the primary lesion and SLN biopsy are the most significant predictors of a melanoma patient's survival [30,31]. González-Álvarez et al [32] investigated the association between dermoscopic structures and SLN status, and found that the presence of an atypical pigmented network was associated with a negative SLN.…”

Section: Dermoscopic Features and Sentinel Lymph Node Positivitymentioning

confidence: 99%

Dermoscopic Features as Predictors of BRAF Mutational Status and Sentinel Lymph Node Positivity in Primary Cutaneous Melanoma

Filipović¹,

Šitum

Buljan

2021

Dermatol Pract Concept

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Dermoscopy is a diagnostic tool widely used in clinical practice for the detection of skin tumors, especially early stages of melanoma. Recent studies have shown that different dermoscopic features are associated with important prognostic parameters of melanoma, such as BRAF mutational status and sentinel lymph node status. More than half of all melanomas harbor a mutation in the BRAF oncogene. The current management of advanced-stage melanomas is greatly determined by the presence or absence of a mutation in this gene, as targeted therapy with BRAF kinase inhibitors is one of the first therapeutic choices for these patients. Sentinel lymph node status is one of the most significant predictors of a melanoma patient’s survival. Recent studies have shown that different dermoscopic patterns are also associated with sentinel lymph node status. This short article reviews studies that investigated correlations between dermoscopic features, BRAF mutation status and sentinel lymph node status.

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Sentinel node biopsy status is strongly predictive of survival in cutaneous melanoma: Extended follow-up of Oxford patients from 1998 to 2014

Cited by 15 publications

References 20 publications

The Clinicopathological and Survival Profiles Comparison Across Primary Sites in Acral Melanoma

The Clinicopathological and Survival Profiles Comparison Across Primary Sites in Acral Melanoma

Optimal surveillance strategies for patients with stage 1 cutaneous melanoma post primary tumour excision: three systematic reviews and an economic model

Dermoscopic Features as Predictors of BRAF Mutational Status and Sentinel Lymph Node Positivity in Primary Cutaneous Melanoma

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