Edmund K Bartlett1, Madalyn G Peters2, Anne Blair3, Mark S Etherington2, David E Elder4, Xiaowei G Xu4, DuPont Guerry5, Michael E Ming6, Douglas L Fraker2, Brian J Czerniecki2, Phyllis A Gimotty3, Giorgos C Karakousis7. 1. Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, USA. edmund.bartlett@uphs.upenn.edu. 2. Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, USA. 3. Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, USA. 4. Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, USA. 5. Hematology-Oncology Division, Department of Medicine, University of Pennsylvania, Philadelphia, USA. 6. Department of Dermatology, University of Pennsylvania, Philadelphia, USA. 7. Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, USA. Giorgos.Karakousis@uphs.upenn.edu.
Abstract
INTRODUCTION: Sentinel lymph node (SLN) biopsy is recommended for all patients with intermediate-thickness melanomas. We sought to identify such patients at low risk of SLN positivity. METHODS: All patients with intermediate-thickness melanomas (1.01-4 mm) undergoing SLN biopsy at a single institution from 1995-2011 were included in this retrospective cohort study. Univariate and multivariate logistic regression determined factors associated with a low risk of SLN positivity. Classification and regression tree (CART) analysis was used to stratify groups based on risk of positivity. RESULTS: Of the 952 study patients, 157 (16.5 %) had a positive SLN. In the multivariate analysis, thickness <1.5 mm (odds ratio [OR] 0.29), age ≥60 (OR 0.69), present tumor-infiltrating lymphocytes (OR 0.60), absent lymphovascular invasion (OR 0.46), and absent satellitosis (OR 0.44) were significantly associated with a low risk of SLN positivity. CART analysis identified thickness of 1.5 mm as the primary cut point for risk of SLN metastasis. Patients with a thickness of <1.5 mm represented 36 % of the total cohort and had a SLN positivity rate of 6.6 % (95 % confidence interval 3.8-9.4 %). In patients with melanomas <1.5 mm in thickness, the presence of additional low risk factors identified 257 patients (75 % of patients with <1.5 mm melanomas) in which the rate of SLN positivity was <5 %. CONCLUSIONS: Despite a SLN positivity rate of 16.5 % overall, substantial heterogeneity of risk exists among patients with intermediate-thickness melanoma. Most patients with melanoma between 1.01 and 1.5 mm have a risk of SLN positivity similar to that in patients with thin melanomas.
INTRODUCTION: Sentinel lymph node (SLN) biopsy is recommended for all patients with intermediate-thickness melanomas. We sought to identify such patients at low risk of SLN positivity. METHODS: All patients with intermediate-thickness melanomas (1.01-4 mm) undergoing SLN biopsy at a single institution from 1995-2011 were included in this retrospective cohort study. Univariate and multivariate logistic regression determined factors associated with a low risk of SLN positivity. Classification and regression tree (CART) analysis was used to stratify groups based on risk of positivity. RESULTS: Of the 952 study patients, 157 (16.5 %) had a positive SLN. In the multivariate analysis, thickness <1.5 mm (odds ratio [OR] 0.29), age ≥60 (OR 0.69), present tumor-infiltrating lymphocytes (OR 0.60), absent lymphovascular invasion (OR 0.46), and absent satellitosis (OR 0.44) were significantly associated with a low risk of SLN positivity. CART analysis identified thickness of 1.5 mm as the primary cut point for risk of SLN metastasis. Patients with a thickness of <1.5 mm represented 36 % of the total cohort and had a SLN positivity rate of 6.6 % (95 % confidence interval 3.8-9.4 %). In patients with melanomas <1.5 mm in thickness, the presence of additional low risk factors identified 257 patients (75 % of patients with <1.5 mm melanomas) in which the rate of SLN positivity was <5 %. CONCLUSIONS: Despite a SLN positivity rate of 16.5 % overall, substantial heterogeneity of risk exists among patients with intermediate-thickness melanoma. Most patients with melanoma between 1.01 and 1.5 mm have a risk of SLN positivity similar to that in patients with thin melanomas.
Authors: Jessica A Cintolo; Phyllis Gimotty; Anne Blair; Dupont Guerry; David E Elder; Rachel Hammond; Rosalie Elenitsas; Xiaowei Xu; Douglas Fraker; Lynn M Schuchter; Brian J Czerniecki; Giorgos Karakousis Journal: Ann Surg Oncol Date: 2013-07-10 Impact factor: 5.344
Authors: Rajmohan Murali; Lauren E Haydu; Michael J Quinn; Robyn P M Saw; Kerwin Shannon; Andrew J Spillane; Jonathan R Stretch; John F Thompson; Richard A Scolyer Journal: Ann Surg Date: 2012-01 Impact factor: 12.969
Authors: Giorgos C Karakousis; Phyllis A Gimotty; Brian J Czerniecki; David E Elder; Rosalie Elenitsas; Michael E Ming; Douglas L Fraker; DuPont Guerry; Francis R Spitz Journal: Ann Surg Oncol Date: 2007-02-07 Impact factor: 5.344
Authors: 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 Journal: J Clin Oncol Date: 2013-11-04 Impact factor: 44.544
Authors: Csaba Gajdos; Kent A Griffith; Sandra L Wong; Timothy M Johnson; Alfred E Chang; Vincent M Cimmino; Lori Lowe; Carol R Bradford; Riley S Rees; Michael S Sabel Journal: Cancer Date: 2009-12-15 Impact factor: 6.860
Authors: Melanie A Warycha; Jan Zakrzewski; Quanhong Ni; Richard L Shapiro; Russell S Berman; Anna C Pavlick; David Polsky; Madhu Mazumdar; Iman Osman Journal: Cancer Date: 2009-02-15 Impact factor: 6.860
Authors: Charles M Balch; Jeffrey E Gershenwald; Seng-Jaw Soong; John F Thompson; Michael B Atkins; David R Byrd; Antonio C Buzaid; Alistair J Cochran; Daniel G Coit; Shouluan Ding; Alexander M Eggermont; Keith T Flaherty; Phyllis A Gimotty; John M Kirkwood; Kelly M McMasters; Martin C Mihm; Donald L Morton; Merrick I Ross; Arthur J Sober; Vernon K Sondak Journal: J Clin Oncol Date: 2009-11-16 Impact factor: 44.544
Authors: Michael P Mays; Robert C G Martin; Alison Burton; Brooke Ginter; Michael J Edwards; Douglas S Reintgen; Merrick I Ross; Marshall M Urist; Arnold J Stromberg; Kelly M McMasters; Charles R Scoggins Journal: Cancer Date: 2010-03-15 Impact factor: 6.860
Authors: James M Chang; Heidi E Kosiorek; Amylou C Dueck; Stanley P L Leong; John T Vetto; Richard L White; Eli Avisar; Vernon K Sondak; Jane L Messina; Jonathan S Zager; Carlos Garberoglio; Mohammed Kashani-Sabet; Barbara A Pockaj Journal: Am J Surg Date: 2017-12-14 Impact factor: 2.565
Authors: D Zugna; R Senetta; S Osella-Abate; M T Fierro; A Pisacane; A Zaccagna; A Sapino; V Bataille; A Maurichi; F Picciotto; P Cassoni; P Quaglino; S Ribero Journal: Br J Cancer Date: 2017-11-09 Impact factor: 7.640
Authors: Flora Yan; Hannah M Knochelmann; Patrick F Morgan; John M Kaczmar; David M Neskey; Evan M Graboyes; Shaun A Nguyen; Besim Ogretmen; Anand K Sharma; Terry A Day Journal: Cancers (Basel) Date: 2020-06-11 Impact factor: 6.639