Size of sentinel node metastases predicts other nodal disease and survival in malignant melanoma

The influence of sentinel lymph node tumour burden on additional lymph node involvement and disease-free survival in cutaneous melanoma – a retrospective analysis of 392 cases

“…The rates for positive CLNDs were not significantly different for SLN macrometastases and micrometastases. This is in accordance with other studies in which reproducible prediction of non-SLN positivity on the basis of SLN tumour burden remained elusive (Ranieri et al, 2002;Carlson et al, 2003;Pearlman et al, 2006;Roka et al, 2008). Additional positive non-SLNs upon CLND are widely recognised to adversely influence prognosis (Carlson et al, 2003).…”

“…Several authors have used this cutoff in analysing their study populations. Despite the fact that 6% of the patients with micrometastases (isolated tumour cells not differentiated) in their SLNs had a positive CLND, Pearlman et al (2006) found that their 5-year survival was at 85% essentially the same as that of patients with a negative SLNB. Carlson et al (2003) have made a similar observation: even though SLN tumour burden was not predictive of non-SLN positivity, the 3-year overall survival for patients with SLN tumour burden p2 mm (including isolated tumour cells) was significantly higher than that for those with SLN tumour deposits of 42 mm (90 vs 57%), irrespective of whether patients had positive CLNDs or not.…”

“…There were four different diagnoses based on the recommendations of the International Union against Cancer: (i) no tumour, (ii) isolated tumour cells, (iii) micrometastasis (o2 mm) and (iv) macrometastasis (42 mm) (Hermanek et al, 1999). As no significant differences between patients with isolated tumour cells and patients with micrometastasis were found, we have summarised both groups under the heading of micrometastasis for this analysis, as described in previous studies (Carlson et al, 2003;Pearlman et al, 2006;Roka et al, 2008).…”

Stage migration after minor changes in histologic estimation of tumor burden in sentinel lymph nodes

“…This may explain some of the discrepant results reported in the literature from such studies. 15,18,19,23,[36][37][38] Microanatomic location of metastases is also based on a hierarchical classification, and intuitively, this pattern cannot become less extensive when adding more steps.…”

Prognostic Factors in Cutaneous Melanoma

“…Moreover, the size of the large deposit in the sentinel node was the only factor linked with positivity in other nodes in the complete lymphadenectomy specimen, but there were no recurrences in patients with deposits <0.2 mm in diameter; the depth and ulceration of the primary tumor were associated in multivariate analyses with clinical recurrence [ 230 ]. In the dataset of Pearlman et al [ 231 ], sentinel lymph node deposits ≤2 mm in diameter were associated with a 6 % rate of positive completion lymphadenectomy and a 5-year survival of 85 %, the overall outcome being the same as sentinel-negative patients [ 231 ]. Node-positive patients with metastatic deposits >2 mm had a 45 % rate of positive complete lymphadenectomy and a 5-year survival of 47 % ( p < 0.0001) [ 231 ].…”