BACKGROUND: The value of the status of the sentinel lymph node (SLN) in patients with thick melanomas (Breslow thickness > or = 4 mm) is controversial. PATIENTS AND METHODS: Using Kaplan-Meier estimates and Cox regression models, we studied 152 patients with primary melanomas > or = 4 mm thickness who underwent sentinel lymph node excision (SLNE) at the university hospitals of Hannover and Göttingen, Germany, between 1998 and 2006. RESULTS: The median tumor thickness was 5.2 (4-18) mm; 58.5% of primary melanomas were ulcerated. Micrometastasis to a SLN was found in 48.7%. The patients with positive SLNs were significantly younger than those with negative SLN (p = 0.01). Of the complete lymph node dissections, 32% contained positive non-SLN. The estimated 5 year recurrence-free survival was 42.5 +/- 5% (+/- standard error) (26.3 +/- 6.6% after positive SLNE, 58.7 +/- 7.1% after negative SLNE). The 5 year overall survival rate was 53.2 +/- 5.4% (37.5 +/- 8.1% after positive SLNE, 67.6 +/- 6.7% after negative SLNE). By multivariate analysis, the SLN was a highly significant predictor for overall survival (p = 0.007, relative risk 2.3, 95%, confidence interval 1.2-4.2). The overall survival was significantly associated with penetration of nodal metastases into the SLN > 0.3 mm (p = 0.001). Other parameters such as tumor thickness, ulceration, age and sex were not significant. In the subgroup of patients with negative SLN, neither tumor thickness nor ulceration was significant. CONCLUSIONS: The status of the SLN represents the most important prognostic parameter in patients with thick melanomas, whereas other parameters such as tumor thickness and ulceration loose their prognostic value.
BACKGROUND: The value of the status of the sentinel lymph node (SLN) in patients with thick melanomas (Breslow thickness > or = 4 mm) is controversial. PATIENTS AND METHODS: Using Kaplan-Meier estimates and Cox regression models, we studied 152 patients with primary melanomas > or = 4 mm thickness who underwent sentinel lymph node excision (SLNE) at the university hospitals of Hannover and Göttingen, Germany, between 1998 and 2006. RESULTS: The median tumor thickness was 5.2 (4-18) mm; 58.5% of primary melanomas were ulcerated. Micrometastasis to a SLN was found in 48.7%. The patients with positive SLNs were significantly younger than those with negative SLN (p = 0.01). Of the complete lymph node dissections, 32% contained positive non-SLN. The estimated 5 year recurrence-free survival was 42.5 +/- 5% (+/- standard error) (26.3 +/- 6.6% after positive SLNE, 58.7 +/- 7.1% after negative SLNE). The 5 year overall survival rate was 53.2 +/- 5.4% (37.5 +/- 8.1% after positive SLNE, 67.6 +/- 6.7% after negative SLNE). By multivariate analysis, the SLN was a highly significant predictor for overall survival (p = 0.007, relative risk 2.3, 95%, confidence interval 1.2-4.2). The overall survival was significantly associated with penetration of nodal metastases into the SLN > 0.3 mm (p = 0.001). Other parameters such as tumor thickness, ulceration, age and sex were not significant. In the subgroup of patients with negative SLN, neither tumor thickness nor ulceration was significant. CONCLUSIONS: The status of the SLN represents the most important prognostic parameter in patients with thick melanomas, whereas other parameters such as tumor thickness and ulceration loose their prognostic value.
Authors: Sandra L Wong; Charles M Balch; Patricia Hurley; Sanjiv S Agarwala; Timothy J Akhurst; Alistair Cochran; Janice N Cormier; Mark Gorman; Theodore Y Kim; Kelly M McMasters; R Dirk Noyes; Lynn M Schuchter; Matias E Valsecchi; Donald L Weaver; Gary H Lyman Journal: J Clin Oncol Date: 2012-07-09 Impact factor: 44.544
Authors: A Mitra; C Conway; C Walker; M Cook; B Powell; S Lobo; M Chan; M Kissin; G Layer; J Smallwood; C Ottensmeier; P Stanley; H Peach; H Chong; F Elliott; M M Iles; J Nsengimana; J H Barrett; D T Bishop; J A Newton-Bishop Journal: Br J Cancer Date: 2010-09-21 Impact factor: 7.640