Small cell melanoma and ulceration as predictors of positive sentinel lymph node in malignant melanoma patients

Abstract

Malignant melanoma (MM) early lymph node (LN) metastasis usually appears first in the sentinel LN (SLN). Breslow thickness is the main factor considered in the selection of patients to be submitted to SLN biopsy. The present study aimed to describe other independent prognostic factors useful in SLN candidate selection. During one year, 94 MM patients (90 primary cutaneous MM with Breslow thickness > or = 0.76 mm, and four cutaneous relapses), were submitted to SLN biopsy in the Melanoma Unit at the Hospital Clinic, Barcelona, Spain. The prognostic factors studied were: Breslow thickness, Clark's level of invasion, mitotic rate, cellular type (small, epithelioid, fusocellular, sarcomatoid), vertical growth phase, regression > 50%, severe vascularization, infiltrate (lymphocytic, plasmocytic), ulceration, neurotropism, intravascular/intraneural invasion, protein p16 expression and recurrence. Nineteen SLN (20.2%) were positive and 75 (79.8%) negative. No positive SLN occurred in MM with Breslow thickness < or = 1.0 mm. Breslow thickness > or = 2 mm (P = 0.005), severe vascularization (P = 0.005), small cell (P = 0.000) and ulceration (P = 0.005) were significant prognostic factors by univariate analysis. Small cell (P = 0.008) and ulceration (P = 0.05) were also significant prognostic factors in a multivariate analysis. The probability of finding a positive SLN for small cell was 56.9% [95% confidence interval (CI), 26.8-82.6%]. The probability of positive SLN for ulceration was 35.5% (95% CI, 14.2-64.7%). For small cell and ulceration together the probability increased to 86.3% (95% CI, 54.3-97.1%). The results of this study corroborated ulceration as a prognostic factor for SLN candidate selection and for the first time we have described small cell melanoma morphology as a significant factor associated with positive SLN.

Lymphatic invasion detected by D2-40/S-100 dual immunohistochemistry does not predict sentinel lymph node status in melanoma

“…The most consistent feature to correlate with sentinel lymph node positivity is increasing Breslow thickness; however, other factors such as younger age, trunk or lower extremity location, ulceration, increasing mitotic rate, and angiolymphatic invasion have also been associated with a greater likelihood of sentinel lymph node involvement. 15,[22][23][24][25]28,31,[33][34] We herein report a similar statistically significant association between positive sentinel lymph node and increasing Breslow thickness, and similar trends in association between positive sentinel lymph node and a younger age, the presence of ulceration, and increased mitoses.…”

“…Breslow thickness remains the most consistent predictor of sentinel lymph node metastases, but other parameters such as ulceration, age, location, angiolymphatic invasion, regression, small cell melanoma histology, and clinical tumor palpability may also be predictive. 15,19,[22][23][24][25][26][27][28][29][30][31][32][33][34] Tumor lymphangiogenesis is an active area of investigation in melanoma and other cancers and is postulated to be a fruitful area for therapeutic targets. 35 Excellent reviews are available discussing tumor lymphangiogenesis and melanoma metastasis.…”

High nevus counts confer a favorable prognosis in melanoma patients

“…For Barcelona, melanoma cases submitted to SLN biopsy were collected from the Melanoma Unit at the Hospital Clinic of Barcelona between October 1996 and 2013 and were recruited from Catalonia as well as further a field as the melanoma clinic at the Hospital Clinic Barcelona is a secondary and tertiary referral center ( N = 678). The Barcelona cohort has been previously described in several studies …”

Meta‐analysis of sentinel lymph node positivity in thin melanoma (≤1 mm)

“…34 Inclusion criteria were commented on in an additional 2 studies, but were not specified. 26,28 Thirty-one of 34 (91.2%) studies commented on the histopathologic examination of SLNs, which consisted of routine hematoxylin and eosin staining, with additional sections evaluated by immunohistochemical staining for S-100 in 2 (6.5%) studies 28,40 ; for MART1/Melan-A in 1 (3.2%) study 26 ; for S-100 and HMB-45 in 17 (54.8%) studies 8, [10][11][12]14,24,27,29,31,32,34,38,[41][42][43][44][45] ; for S-100 and MART1/Melan-A in 2 (6.5%) studies 21,39 ; for HMB-45 and MART/Melan-A in 2 (6.5%) studies 25,46 ; and for Cancer S100, HMB-45, and MART1/Melan-A in 6 (19.4%) studies. 9,22,30,33,35,37 The specific immunostains were not reported in 1 study.…”