BACKGROUND: Sentinel lymph node (SLN) biopsy (SLNB) for pT1 melanomas is not generally recognized as a clinical standard. We studied the value of SLNB for pT1 melanoma patients having at least one additional risk factor. PATIENTS: Among 931 patients with SLNB, 210 had pT1 melanomas. All of the latter showed at least one of the following risk factors: ulceration (4 %) Clark level IV (44 %), nodular growth pattern (11 %), mitoses (59 %), regression (38 %) or age ≤ 40 years (27 %). RESULTS: In this selected pT1 population, we observed a surprisingly high SLN positivity rate of 18 %. The melanoma-specific overall survival significantly depended on SLN status. Compared with Clark IV, a lower invasion level (Clark II/III) was associated with a higher proportion of positive SLNs (25 vs. 10 %; p < 0.01). There was a trend towards a higher SLN positivity rate in younger patients (p = 0.06). Breslow, ulceration, mitoses, nodular growth pattern, and sex did not reach significance. Regression was significantly more frequently found in very thin melanomas (≤ 0.75 mm) and tended to be significant in this subgroup (p = 0.075). CONCLUSIONS: SLNB improves prognostic stratification in patients with thin melanomas having an additional risk factor. Clark level IV most likely does not belong to these risk factors. The impact of regression deserves further consideration. Our data suggest that SLNB should be offered to patients with thin melanomas, if ulceration, nodular growth pattern, mitoses, or regression are present, or if the patient is younger than 40 years of age.
BACKGROUND: Sentinel lymph node (SLN) biopsy (SLNB) for pT1melanomas is not generally recognized as a clinical standard. We studied the value of SLNB for pT1melanomapatients having at least one additional risk factor. PATIENTS: Among 931 patients with SLNB, 210 had pT1melanomas. All of the latter showed at least one of the following risk factors: ulceration (4 %) Clark level IV (44 %), nodular growth pattern (11 %), mitoses (59 %), regression (38 %) or age ≤ 40 years (27 %). RESULTS: In this selected pT1 population, we observed a surprisingly high SLN positivity rate of 18 %. The melanoma-specific overall survival significantly depended on SLN status. Compared with Clark IV, a lower invasion level (Clark II/III) was associated with a higher proportion of positive SLNs (25 vs. 10 %; p < 0.01). There was a trend towards a higher SLN positivity rate in younger patients (p = 0.06). Breslow, ulceration, mitoses, nodular growth pattern, and sex did not reach significance. Regression was significantly more frequently found in very thin melanomas (≤ 0.75 mm) and tended to be significant in this subgroup (p = 0.075). CONCLUSIONS: SLNB improves prognostic stratification in patients with thin melanomas having an additional risk factor. Clark level IV most likely does not belong to these risk factors. The impact of regression deserves further consideration. Our data suggest that SLNB should be offered to patients with thin melanomas, if ulceration, nodular growth pattern, mitoses, or regression are present, or if the patient is younger than 40 years of age.
Authors: K M Joyce; N M McInerney; C W Joyce; D M Jones; A J Hussey; P Donnellan; M J Kerin; J L Kelly; P J Regan Journal: Ir J Med Sci Date: 2014-11-01 Impact factor: 1.568
Authors: Christina Bluemel; Ken Herrmann; Francesco Giammarile; Omgo E Nieweg; Julien Dubreuil; Alessandro Testori; Riccardo A Audisio; Odysseas Zoras; Michael Lassmann; Annette H Chakera; Roger Uren; Sotirios Chondrogiannis; Patrick M Colletti; Domenico Rubello Journal: Eur J Nucl Med Mol Imaging Date: 2015-07-25 Impact factor: 9.236
Authors: Andrew J Sinnamon; Madalyn G Neuwirth; Pratyusha Yalamanchi; Phyllis Gimotty; David E Elder; Xiaowei Xu; Rachel R Kelz; Robert E Roses; Emily Y Chu; Michael E Ming; Douglas L Fraker; Giorgos C Karakousis Journal: JAMA Dermatol Date: 2017-09-01 Impact factor: 10.282
Authors: A Kocsis; L Karsko; Zs Kurgyis; Zs Besenyi; L Pavics; E Dosa-Racz; E Kis; E Baltas; H Ocsai; E Varga; B Bende; A Varga; G Mohos; I Korom; J Varga; L Kemeny; I B Nemeth; J Olah Journal: Pathol Oncol Res Date: 2019-12-02 Impact factor: 3.201