A Tejera-Vaquerizo1,2, G Pérez-Cabello1, L Marínez-Leborans3, E Gallego4, V Oliver-Martínez3, P Martín-Cuevas1, S Arias-Santiago5, J Aneiros-Fernández6, E Herrera-Acosta1, V Traves7, E Herrera-Ceballos1, E Nagore8. 1. Servicio de Dermatología, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria/Universidad de Málaga, Málaga, Spain. 2. Servicio de Dermatología, Instituto dermatológico Globalderm, Palma del Río, Córdoba, Spain. 3. Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, Spain. 4. Servicio de Anatomía Patológica, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria/Universidad de Málaga, Málaga, Spain. 5. Unidad de Dermatología, Instituto de Investigaciones Biosanitarias IBS, Granada, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain. 6. Unidad de Anatomía Patológica, Instituto de Investigaciones Biosanitarias IBS, Granada, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain. 7. Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, Spain. 8. Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, Spain.
Abstract
BACKGROUND: T1 melanoma substaging was recently modified by the American Joint Committee on Cancer (AJCC). Although sentinel lymph node (SLN) positivity is the most important prognostic factor in melanoma, there is a lack of consensus on whether SLN biopsy should be performed in patients with thin melanoma (≤1 mm). OBJECTIVE: The main aim of this study was to investigate predictors of SLN positivity in patients with thin melanoma, with a special emphasis on mitotic rate. A secondary aim was to evaluate survival in this group of patients. MATERIALS AND METHODS: Retrospective multicenter observational study with analysis of age, sex, tumour location, thickness, mitotic rate, regression and microscopic satellites. Predictive factors were identified using a classification and regression tree (CART) approach. Melanoma-specific survival according to SLN status was estimated using Kaplan-Meier curves. RESULTS: We analysed 203 patients with a melanoma ≤1 mm. Using the new AJCC staging criteria, the CART algorithm identified a 7.5% likelihood of SLN positivity in T1a patients. In the case of T1b melanoma, there was a 14.3% likelihood of SLN positivity in patients with a mitotic rate >1 mitosis/mm2 and a 3.2% likelihood in those with ≤1 mitoses/mm2 . None of the patients with T1b disease who had ≤1 mitoses/mm2 and regression had SLN positivity. In T1b patients, 5-year melanoma-specific survival was 98.7% in the SLN-negative group and 75% in the SLN-positive group (P = 0.05). When stratified by mitotic rate, survival was 100% for patients with a mitotic rate of ≤1 mitoses/mm2 and 91.4% for those with >1 mitosis/mm2 (P = 0.022). There were no deaths in the T1a subgroup. CONCLUSIONS: Sentinel lymph node metastasis was less common in patients with T1b melanoma who had a mitotic rate of ≤1 mitoses/mm2 . Performance of SLN biopsy should be carefully considered in this subgroup of patients, particularly considering the good prognosis.
BACKGROUND: T1 melanoma substaging was recently modified by the American Joint Committee on Cancer (AJCC). Although sentinel lymph node (SLN) positivity is the most important prognostic factor in melanoma, there is a lack of consensus on whether SLN biopsy should be performed in patients with thin melanoma (≤1 mm). OBJECTIVE: The main aim of this study was to investigate predictors of SLN positivity in patients with thin melanoma, with a special emphasis on mitotic rate. A secondary aim was to evaluate survival in this group of patients. MATERIALS AND METHODS: Retrospective multicenter observational study with analysis of age, sex, tumour location, thickness, mitotic rate, regression and microscopic satellites. Predictive factors were identified using a classification and regression tree (CART) approach. Melanoma-specific survival according to SLN status was estimated using Kaplan-Meier curves. RESULTS: We analysed 203 patients with a melanoma ≤1 mm. Using the new AJCC staging criteria, the CART algorithm identified a 7.5% likelihood of SLN positivity in T1a patients. In the case of T1b melanoma, there was a 14.3% likelihood of SLN positivity in patients with a mitotic rate >1 mitosis/mm2 and a 3.2% likelihood in those with ≤1 mitoses/mm2 . None of the patients with T1b disease who had ≤1 mitoses/mm2 and regression had SLN positivity. In T1b patients, 5-year melanoma-specific survival was 98.7% in the SLN-negative group and 75% in the SLN-positive group (P = 0.05). When stratified by mitotic rate, survival was 100% for patients with a mitotic rate of ≤1 mitoses/mm2 and 91.4% for those with >1 mitosis/mm2 (P = 0.022). There were no deaths in the T1a subgroup. CONCLUSIONS: Sentinel lymph node metastasis was less common in patients with T1b melanoma who had a mitotic rate of ≤1 mitoses/mm2 . Performance of SLN biopsy should be carefully considered in this subgroup of patients, particularly considering the good prognosis.
Authors: A Piñero-Madrona; G Ruiz-Merino; P Cerezuela Fuentes; E Martínez-Barba; J N Rodríguez-López; J Cabezas-Herrera Journal: Clin Transl Oncol Date: 2019-02-19 Impact factor: 3.405
Authors: Antonio Tejera-Vaquerizo; Simone Ribero; Susana Puig; Aram Boada; Sabela Paradela; David Moreno-Ramírez; Javier Cañueto; Blanca de Unamuno; Ana Brinca; Miguel A Descalzo-Gallego; Simona Osella-Abate; Paola Cassoni; Cristina Carrera; Sergi Vidal-Sicart; Antoni Bennássar; Ramón Rull; Llucìa Alos; Celia Requena; Isidro Bolumar; Víctor Traves; Ángel Pla; A Fernández-Orland; Ane Jaka; María T Fernández-Figueres; Josep M Hilari; Pol Giménez-Xavier; Ricardo Vieira; Rafael Botella-Estrada; Concepción Román-Curto; Lara Ferrándiz; Nicolás Iglesias-Pena; Carlos Ferrándiz; Josep Malvehy; Pietro Quaglino; Eduardo Nagore Journal: Cancer Med Date: 2019-06-18 Impact factor: 4.452
Authors: Alessandra Buja; Andrea Bardin; Giovanni Damiani; Manuel Zorzi; Chiara De Toni; Riccardo Fusinato; Romina Spina; Antonella Vecchiato; Paolo Del Fiore; Simone Mocellin; Vincenzo Baldo; Massimo Rugge; Carlo Riccardo Rossi Journal: Front Oncol Date: 2021-11-16 Impact factor: 6.244
Authors: Alberto Julius Alves Wainstein; João Pedreira Duprat Neto; Mauro Yoshiaki Enokihara; Eduard René Brechtbühl; Felice Riccardi; Gilles Landman; Andreia Cristina de Melo; Vinicius de Lima Vazquez; Rodrigo Ramella Munhoz; Ivan Dunshee De Abranches Oliveira Santos Filho; Eduardo Bertolli; Ana Paula Drummond-Lage; Bianca Costa Soares de Sá; Luciane Botelho; Jose Higino Steck; Francisco Aparecido Belfort; Marcus Maia; Renato Marchiori Bakos; Elimar Elias Gomes; Rafael Schmerling; Flavio Cavarsan Journal: JCO Glob Oncol Date: 2020-04