The Prognostic Implications of Microscopic Satellites in Patients With Clinical Stage I Melanoma

Abstract

Controversy exists as to whether microscopic satellites influence prognosis or patterns of progressive disease in patients with clinical stage I melanoma. Fifty patients with clinical stage I melanoma and microscopic satellites were prospectively studied from 1972 to 1984. To allow for complete histopathology assessment, 30 patients with microscopic satellites who were prospectively seen from 1972 to 1979 were matched to a cohort of 77 patients with vertical growth-phase melanoma without microscopic satellites according to six attributes. The matched cohort study showed that the presence of microscopic satellites appeared to be associated with increased local regional cutaneous and regional nodal disease and a significantly decreased actuarial disease-free survival. A Cox multivariate regression analysis that involved 384 patients with vertical growth-phase clinical stage I melanoma showed that the presence of microscopic satellites independently predicted a poorer disease-free survival and overall survival. Therefore, this study demonstrated that the presence of microscopic satellites correlated with a significantly decreased survival.

Final Version of the American Joint Committee on Cancer Staging System for Cutaneous Melanoma

“…The presence of clinical or microscopic satellite metastases around a primary melanoma as well as in-transit metastases between the primary melanoma and the regional lymph nodes represent intralymphatic metastases and portend a poor prognosis. 4,[40][41][42][43] The available data show no substantial difference in survival outcome for these two anatomically defined entities. 4 Therefore, they are both assigned to a separate N2c classification in the absence of synchronous nodal metastases because both have a prognosis equivalent to multiple nodal metastases (Tables 2 and 3).…”

“…The presence of clinical or microscopic satellite metastases around a primary melanoma as well as in-transit metastases between the primary melanoma and the regional lymph nodes represent intralymphatic metastases and portend a poor prognosis. 4,[40][41][42][43] The available data show no substantial difference in survival outcome for these two anatomically defined entities.4 Therefore, they are both assigned to a separate N2c classification in the absence of synchronous nodal metastases because both have a prognosis equivalent to multiple nodal metastases (Tables 2 and 3). Furthermore, the available data demonstrate that patients with a combination of satellites and in-transit metastases plus nodal metastases have a worse outcome than patients who experience either event alone, so these patients were assigned to a N3 classification regardless of the number of synchronous metastatic nodes (Tables 2 and 3).…”

Prognosticators of melanoma, the melanoma report, and the sentinel lymph node

“…10,53,[86][87][88][89] Clark et al 10 found a reduction of actuarial 8-year survival from 75 to 40% when satellites were identified. It has been suggested that this is a difficult criterion to assess, as tumor tongues radiating from the main vertical growth phase nodule may mimic satellites due to artifacts of sectioning.…”

The Role of Microsatellites as a Prognostic Factor in Primary Malignant Melanoma

“…Subsequent survival analyses have revealed decreased survival and increased probabilityofregionalrelapseamongpatients with evidence of microsatellites in their primary tumor. 2,3 Recently, the latest version of the American Joint Committee on Cancer (AJCC) staging classification for melanoma 4 has up-staged microsatellites to the N classification of the TNM system. Specifically, patients with microsatellites are assigned to the pathologic N2c and clinical IIIB staging categories, prognostically placing them alongside patients with intransit and clinical satellite metastases (macrosatellites).…”