The pathological features of melanoma biopsies can provide significant prognostic information that can help the surgeon evaluate the risk of nodal disease. The aim of this study was to attempt to determine the relationship between pathological features of primary melanoma and nodal disease, by sentinel node biopsy (SNB) and complete node dissection (CND).
Methods
A retrospective analysis was completed of patients who underwent SNB at AC Camargo Cancer Center, Sao Paulo, Brazil, between 2000 and 2010.
Results
A total of 697 patients were evaluated. By univariate analysis, it was found that histology, Clark level, Breslow depth, mitotic index, ulceration, regression, lymphatic and perineural invasion and satellitosis were significantly associated with SNB positivity. In the multivariate analysis, it was found that Breslow depth, mitotic index, ulceration, regression, lymphatic invasion and satellitosis were significant factors. In patients with a positive SNB, the primary tumor site, Clark level and Breslow depth greater than 2 mm were significantly related to non-sentinel node (NSN) positivity by univariate analysis. By multivariate analysis, Breslow depth greater than 2 mm was the only primary tumor feature that was significantly related (p = 0.038).
Conclusions
The indication of SNB should not be based solely on Breslow depth and ulceration or mitotic index. A complete evaluation of the pathological report should improve the identification of high-risk patients.
MortonD.L., WenD.R., WongJ.H.Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg.1992; 127(4): 392–399. Available at: http://www.ncbi.nlm.nih.gov/pubmed/1558490. Accessed October 23, 2013.
2.
MortonD.L., ThompsonJ.F., CochranA.J.; MSLT Group. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med.2014; 370(7): 599–609.
3.
CallenderG.G., EggerM.E., BurtonA.L.Prognostic implications of anatomic location of primary cutaneous melanoma of 1 mm or thicker. Am J Surg.2011; 202(6): 659–664, discussion 664-665.
4.
MozzilloN., PennacchioliE., GandiniS.Sentinel node biopsy in thin and thick melanoma. Ann Surg Oncol.2013; 20(8): 2780–2786.
5.
MuraliR., DesilvaC., ThompsonJ.F., ScolyerR.A.Non-Sentinel Node Risk Score (N-SNORE): a scoring system for accurately stratifying risk of non-sentinel node positivity in patients with cutaneous melanoma with positive sentinel lymph nodes. J Clin Oncol.2010; 28(29): 4441–4449.
6.
BartlettE.K., GimottyP.A., SinnamonA.J.Clark level risk stratifies patients with mitogenic thin melanomas for sentinel lymph node biopsy. Ann Surg Oncol.2014 Feb;21(2): 643–9.
7.
BogenriederT., van DijkM.R., BlokxW.A.No non-sentinel node involvement in melanoma patients with limited Breslow thickness and low sentinel node tumour load. Histopathology.2011; 59(2): 318–326.
8.
NagarajaV., EslickG.D.Is complete lymph node dissection after a positive sentinel lymph node biopsy for cutaneous melanoma always necessary? A meta-analysis. Eur J Surg Oncol.2013; 39(7): 669–680.
9.
PasqualiS., SpillaneA.J., de WiltJ.H.W.Surgeons' opinions on lymphadenectomy in melanoma patients with positive sentinel nodes: a worldwide web-based survey. Ann Surg Oncol.2012; 19(13): 4322–4329.
10.
NoweckiZ.I., RutkowskiP., MichejW.The survival benefit to patients with positive sentinel node melanoma after completion lymph node dissection may be limited to the subgroup with a primary lesion Breslow thickness greater than 1.0 and less than or equal to 4 mm. Ann Surg Oncol.2008; 15(8): 2223–2234.
11.
van der PloegI.M.C., KroonB.B.R., AntoniniN., Valdés OlmosR.A., NiewegO.E.Is completion lymph node dissection needed in case of minimal melanoma metastasis in the sentinel node?Ann Surg.2009; 249(6): 1003–1007.
12.
BalchC.M., GershenwaldJ.E., SoongS-JFinal version of 2009 AJCC melanoma staging and classification. J Clin Oncol.2009; 27(36): 6199–6206.
WongS.L., BalchC.M., HurleyP.Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology joint clinical practice guideline. Ann Surg Oncol.2012 Oct;19(11): 3313–24.
15.
EggerM.E., CallenderG.G., McMastersK.M.Diversity of stage III melanoma in the era of sentinel lymph node biopsy. Ann Surg Oncol.2013; 20(3): 956–963.
16.
EggermontA.M.M., RobertC.New drugs in melanoma: it's a whole new world. Eur J Cancer.2011; 47(14): 2150–2157.
17.
HanD., YuD., ZhaoX.Sentinel node biopsy is indicated for thin melanomas ≥0.76 mm. Ann Surg Oncol.2012; 19(11): 3335–3342.
18.
de VriesM., SpeijersM.J., BastiaannetE.Long-term follow-up reveals that ulceration and sentinel lymph node status are the strongest predictors for survival in patients with primary cutaneous melanoma. Eur J Surg Oncol.2011; 37(8): 681–687.
19.
WeversK.P., MuraliR., BastiaannetE.Assessment of a new scoring system for predicting non-sentinel node positivity in sentinel node-positive melanoma patients. Eur J Surg Oncol.2013; 39(2): 179–184.
20.
KimseyT.F., CohenT., PatelA., BusamK.J., BradyM.S.Microscopic satellitosis in patients with primary cutaneous melanoma: implications for nodal basin staging. Ann Surg Oncol.2009; 16(5): 1176–1183.
21.
XuX., GimottyP.A., GuerryD., KarakousisG., ElderD.E.Lymphatic invasion as a prognostic biomarker in primary cutaneous melanoma. Methods Mol Biol.2014; 1102: 275–286.
22.
EttlT., IrgaS., MüllerS.Value of anatomic site, histology and clinicopathological parameters for prediction of lymph node metastasis and overall survival in head and neck melanomas. J Craniomaxillofac Surg.2014; 42(5): 1–7.
23.
CochranA.J., StarzH., OhsieS.J., SarantopoulosG.P., HaasC.J., BinderS.Pathologic reporting and special diagnostic techniques for melanoma. Surg Oncol Clin N Am.2006; 15(2): 231–251.
24.
ColeC.M., FerringerT.Histopathologic evaluation of the sentinel lymph node for malignant melanoma: the unstandard-ized process. Am J Dermatopathol.2014; 36(1): 80–7.
25.
DekkerJ., DuncanL.M.Lack of standards for the detection of melanoma in sentinel lymph nodes: a survey and recommendations. Arch Pathol Lab Med.2013; 137(11): 1603–1609.
26.
van AkkooiA.C.J., NoweckiZ.I., VoitC.Sentinel node tumor burden according to the Rotterdam criteria is the most important prognostic factor for survival in melanoma patients: a multicenter study in 388 patients with positive sentinel nodes. Ann Surg.2008; 248(6): 949–955.
StarzH., SiedleckiK., BaldaB.Sentinel Lymphonodectomy and S-classification: a successful strategy for better prediction and improvement of outcome of melanoma. Ann Surg Oncol.2006; 11(3): 162–168.
29.
PasqualiS., MocellinS., CampanaL.G.Early (sentinel lymph node biopsy-guided) versus delayed lymphadenectomy in melanoma patients with lymph node metastases: personal experience and literature meta-analysis. Cancer.2010; 116(5): 1201–1209.
30.
SpillaneA.J., PasqualiS., HayduL.E., ThompsonJ.F.Patterns of recurrence and survival after lymphadenectomy in melanoma patients: clarifying the effects of timing of surgery and lymph node tumor burden. Ann Surg Oncol.2014; 21(1): 292–299.
31.
GershenwaldJ.E., AndtbackaR.H., PrietoV.G.Microscopic tumor burden in sentinel lymph nodes predicts synchronous nonsentinel lymph node involvement in patients with melanoma. J Clin Oncol.2008; 26(26): 4296–4303.
