Clinicopathologic predictors of sentinel lymph node metastasis in thin melanoma

Dale Han, Jonathan S. Zager, Yu Shyr, Heidi Chen, Lynne D. Berry, Sanjana Iyengar, Mia Djulbegovic, Jaimie L. Weber, Suroosh S. Marzban, Vernon K. Sondak, Jane L. Messina, John T. Vetto, Richard L. White, Barbara Pockaj, Nicola Mozzillo, Kim James Charney, Eli Avisar, Robert Krouse, Mohammed Kashani-Sabet, Stanley P. Leong

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Abstract

Purpose Indications for sentinel lymph node biopsy (SLNB) for thin melanoma are continually evolving. We present a large multi-institutional study to determine factors predictive of sentinel lymph node (SLN) metastasis in thin melanoma. Patients and Methods Retrospective review of the Sentinel Lymph Node Working Group database from 1994 to 2012 identified 1,250 patients who had an SLNB and thin melanomas (< 1 mm). Clinicopathologic characteristics were correlated with SLN status and outcome. Results SLN metastases were detected in 65 (5.2%) of 1,250 patients. On univariable analysis, rates of Breslow thickness ≥ 0.75 mm, Clark level ≥ IV, ulceration, and absence of regression differed significantly between positive and negative SLN groups (all P < .05). These four variables and mitotic rate were used in multivariable analysis, which demonstrated that Breslow thickness ≥ 0.75 mm (P ≥ .03), Clark level ≥ IV (P ≥ .05), and ulceration (P ≥ .01) significantly predicted SLN metastasis with 6.3%, 7.0%, and 11.6% of the patients with these respective characteristics having SLN disease. Melanomas ≥ 0.75 mm had positive SLN rates of ≥ 5% regardless of Clark level and ulceration status. Median follow-up was 2.6 years. Melanoma-specific survival was significantly worse for patients with positive versus negative SLNs (P ≥ .001). Conclusion Breslow thickness ≥ 0.75 mm, Clark level ≥ IV, and ulceration significantly predict SLN disease in thin melanoma. Most SLN metastases (86.2%) occur in melanomas ≥ 0.75 mm, with 6.3% of these patients having SLN disease, whereas in melanomas ≥ 0.75 mm, SLN metastasis rates are ≥ 5%. By using a 5% metastasis risk threshold, SLNB is indicated for melanomas ≥ 0.75 mm, but further study is needed to define indications for SLNB in melanomas ≥ 0.75 mm.

Original languageEnglish
Pages (from-to)4387-4393
Number of pages7
JournalJournal of Clinical Oncology
Volume31
Issue number35
DOIs
StatePublished - Dec 10 2013

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Melanoma
Neoplasm Metastasis
Sentinel Lymph Node Biopsy
Sentinel Lymph Node
Databases
Survival

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

Han, D., Zager, J. S., Shyr, Y., Chen, H., Berry, L. D., Iyengar, S., ... Leong, S. P. (2013). Clinicopathologic predictors of sentinel lymph node metastasis in thin melanoma. Journal of Clinical Oncology, 31(35), 4387-4393. https://doi.org/10.1200/JCO.2013.50.1114

Clinicopathologic predictors of sentinel lymph node metastasis in thin melanoma. / Han, Dale; Zager, Jonathan S.; Shyr, Yu; Chen, Heidi; Berry, Lynne D.; Iyengar, Sanjana; Djulbegovic, Mia; Weber, Jaimie L.; Marzban, Suroosh S.; Sondak, Vernon K.; Messina, Jane L.; Vetto, John T.; White, Richard L.; Pockaj, Barbara; Mozzillo, Nicola; James Charney, Kim; Avisar, Eli; Krouse, Robert; Kashani-Sabet, Mohammed; Leong, Stanley P.

In: Journal of Clinical Oncology, Vol. 31, No. 35, 10.12.2013, p. 4387-4393.

Research output: Contribution to journalArticle

Han, D, Zager, JS, Shyr, Y, Chen, H, Berry, LD, Iyengar, S, Djulbegovic, M, Weber, JL, Marzban, SS, Sondak, VK, Messina, JL, Vetto, JT, White, RL, Pockaj, B, Mozzillo, N, James Charney, K, Avisar, E, Krouse, R, Kashani-Sabet, M & Leong, SP 2013, 'Clinicopathologic predictors of sentinel lymph node metastasis in thin melanoma', Journal of Clinical Oncology, vol. 31, no. 35, pp. 4387-4393. https://doi.org/10.1200/JCO.2013.50.1114
Han, Dale ; Zager, Jonathan S. ; Shyr, Yu ; Chen, Heidi ; Berry, Lynne D. ; Iyengar, Sanjana ; Djulbegovic, Mia ; Weber, Jaimie L. ; Marzban, Suroosh S. ; Sondak, Vernon K. ; Messina, Jane L. ; Vetto, John T. ; White, Richard L. ; Pockaj, Barbara ; Mozzillo, Nicola ; James Charney, Kim ; Avisar, Eli ; Krouse, Robert ; Kashani-Sabet, Mohammed ; Leong, Stanley P. / Clinicopathologic predictors of sentinel lymph node metastasis in thin melanoma. In: Journal of Clinical Oncology. 2013 ; Vol. 31, No. 35. pp. 4387-4393.
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title = "Clinicopathologic predictors of sentinel lymph node metastasis in thin melanoma",
abstract = "Purpose Indications for sentinel lymph node biopsy (SLNB) for thin melanoma are continually evolving. We present a large multi-institutional study to determine factors predictive of sentinel lymph node (SLN) metastasis in thin melanoma. Patients and Methods Retrospective review of the Sentinel Lymph Node Working Group database from 1994 to 2012 identified 1,250 patients who had an SLNB and thin melanomas (< 1 mm). Clinicopathologic characteristics were correlated with SLN status and outcome. Results SLN metastases were detected in 65 (5.2{\%}) of 1,250 patients. On univariable analysis, rates of Breslow thickness ≥ 0.75 mm, Clark level ≥ IV, ulceration, and absence of regression differed significantly between positive and negative SLN groups (all P < .05). These four variables and mitotic rate were used in multivariable analysis, which demonstrated that Breslow thickness ≥ 0.75 mm (P ≥ .03), Clark level ≥ IV (P ≥ .05), and ulceration (P ≥ .01) significantly predicted SLN metastasis with 6.3{\%}, 7.0{\%}, and 11.6{\%} of the patients with these respective characteristics having SLN disease. Melanomas ≥ 0.75 mm had positive SLN rates of ≥ 5{\%} regardless of Clark level and ulceration status. Median follow-up was 2.6 years. Melanoma-specific survival was significantly worse for patients with positive versus negative SLNs (P ≥ .001). Conclusion Breslow thickness ≥ 0.75 mm, Clark level ≥ IV, and ulceration significantly predict SLN disease in thin melanoma. Most SLN metastases (86.2{\%}) occur in melanomas ≥ 0.75 mm, with 6.3{\%} of these patients having SLN disease, whereas in melanomas ≥ 0.75 mm, SLN metastasis rates are ≥ 5{\%}. By using a 5{\%} metastasis risk threshold, SLNB is indicated for melanomas ≥ 0.75 mm, but further study is needed to define indications for SLNB in melanomas ≥ 0.75 mm.",
author = "Dale Han and Zager, {Jonathan S.} and Yu Shyr and Heidi Chen and Berry, {Lynne D.} and Sanjana Iyengar and Mia Djulbegovic and Weber, {Jaimie L.} and Marzban, {Suroosh S.} and Sondak, {Vernon K.} and Messina, {Jane L.} and Vetto, {John T.} and White, {Richard L.} and Barbara Pockaj and Nicola Mozzillo and {James Charney}, Kim and Eli Avisar and Robert Krouse and Mohammed Kashani-Sabet and Leong, {Stanley P.}",
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T1 - Clinicopathologic predictors of sentinel lymph node metastasis in thin melanoma

AU - Han, Dale

AU - Zager, Jonathan S.

AU - Shyr, Yu

AU - Chen, Heidi

AU - Berry, Lynne D.

AU - Iyengar, Sanjana

AU - Djulbegovic, Mia

AU - Weber, Jaimie L.

AU - Marzban, Suroosh S.

AU - Sondak, Vernon K.

AU - Messina, Jane L.

AU - Vetto, John T.

AU - White, Richard L.

AU - Pockaj, Barbara

AU - Mozzillo, Nicola

AU - James Charney, Kim

AU - Avisar, Eli

AU - Krouse, Robert

AU - Kashani-Sabet, Mohammed

AU - Leong, Stanley P.

PY - 2013/12/10

Y1 - 2013/12/10

N2 - Purpose Indications for sentinel lymph node biopsy (SLNB) for thin melanoma are continually evolving. We present a large multi-institutional study to determine factors predictive of sentinel lymph node (SLN) metastasis in thin melanoma. Patients and Methods Retrospective review of the Sentinel Lymph Node Working Group database from 1994 to 2012 identified 1,250 patients who had an SLNB and thin melanomas (< 1 mm). Clinicopathologic characteristics were correlated with SLN status and outcome. Results SLN metastases were detected in 65 (5.2%) of 1,250 patients. On univariable analysis, rates of Breslow thickness ≥ 0.75 mm, Clark level ≥ IV, ulceration, and absence of regression differed significantly between positive and negative SLN groups (all P < .05). These four variables and mitotic rate were used in multivariable analysis, which demonstrated that Breslow thickness ≥ 0.75 mm (P ≥ .03), Clark level ≥ IV (P ≥ .05), and ulceration (P ≥ .01) significantly predicted SLN metastasis with 6.3%, 7.0%, and 11.6% of the patients with these respective characteristics having SLN disease. Melanomas ≥ 0.75 mm had positive SLN rates of ≥ 5% regardless of Clark level and ulceration status. Median follow-up was 2.6 years. Melanoma-specific survival was significantly worse for patients with positive versus negative SLNs (P ≥ .001). Conclusion Breslow thickness ≥ 0.75 mm, Clark level ≥ IV, and ulceration significantly predict SLN disease in thin melanoma. Most SLN metastases (86.2%) occur in melanomas ≥ 0.75 mm, with 6.3% of these patients having SLN disease, whereas in melanomas ≥ 0.75 mm, SLN metastasis rates are ≥ 5%. By using a 5% metastasis risk threshold, SLNB is indicated for melanomas ≥ 0.75 mm, but further study is needed to define indications for SLNB in melanomas ≥ 0.75 mm.

AB - Purpose Indications for sentinel lymph node biopsy (SLNB) for thin melanoma are continually evolving. We present a large multi-institutional study to determine factors predictive of sentinel lymph node (SLN) metastasis in thin melanoma. Patients and Methods Retrospective review of the Sentinel Lymph Node Working Group database from 1994 to 2012 identified 1,250 patients who had an SLNB and thin melanomas (< 1 mm). Clinicopathologic characteristics were correlated with SLN status and outcome. Results SLN metastases were detected in 65 (5.2%) of 1,250 patients. On univariable analysis, rates of Breslow thickness ≥ 0.75 mm, Clark level ≥ IV, ulceration, and absence of regression differed significantly between positive and negative SLN groups (all P < .05). These four variables and mitotic rate were used in multivariable analysis, which demonstrated that Breslow thickness ≥ 0.75 mm (P ≥ .03), Clark level ≥ IV (P ≥ .05), and ulceration (P ≥ .01) significantly predicted SLN metastasis with 6.3%, 7.0%, and 11.6% of the patients with these respective characteristics having SLN disease. Melanomas ≥ 0.75 mm had positive SLN rates of ≥ 5% regardless of Clark level and ulceration status. Median follow-up was 2.6 years. Melanoma-specific survival was significantly worse for patients with positive versus negative SLNs (P ≥ .001). Conclusion Breslow thickness ≥ 0.75 mm, Clark level ≥ IV, and ulceration significantly predict SLN disease in thin melanoma. Most SLN metastases (86.2%) occur in melanomas ≥ 0.75 mm, with 6.3% of these patients having SLN disease, whereas in melanomas ≥ 0.75 mm, SLN metastasis rates are ≥ 5%. By using a 5% metastasis risk threshold, SLNB is indicated for melanomas ≥ 0.75 mm, but further study is needed to define indications for SLNB in melanomas ≥ 0.75 mm.

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