James M Chang1, Heidi E Kosiorek2, Amylou C Dueck2, Stanley P L Leong3, John T Vetto4, Richard L White5, Eli Avisar6, Vernon K Sondak7, Jane L Messina7, Jonathan S Zager7, Carlos Garberoglio8, Mohammed Kashani-Sabet3, Barbara A Pockaj9. 1. Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA. 2. Section of Biostatistics, Mayo Clinic Arizona, Phoenix, AZ, USA. 3. Center for Melanoma Research and Treatment, Department of Surgery, California Pacific Medical Center, San Francisco, CA, USA. 4. Department of Surgery, Oregon Health & Science University, Portland, OR, USA. 5. Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC, USA. 6. Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA. 7. Departments of Cutaneous Oncology and Sarcoma, Moffitt Cancer Center, Tampa, FL, USA. 8. Department of Surgery, Loma Linda University School of Medicine, Loma Linda, CA, USA. 9. Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA. Electronic address: pockaj.barbara@mayo.edu.
Abstract
BACKGROUND: Guidelines for melanoma recommend sentinel lymph node biopsy (SLNB) in patients with melanomas ≥1 mm thickness. Recent single institution studies have found tumors <1.5 mm a low-risk group for positive SLNB. METHODS: A retrospective review of the Sentinel Lymph Node Working Group multicenter database identified patients with intermediate thickness melanoma (1.01-4.00 mm) who had SLNB, and assessed predictors for positive SLNB. RESULTS: 3460 patients were analyzed, 584 (17%) had a positive SLNB. Univariate factors associated with a positive SLNB included age <60 (p < .001), tumor on the trunk/lower extremity (p < .001), Breslow depth ≥2 mm (p < .001), ulceration (p < .001), mitotic rate ≥1/mm2 (p = .01), and microsatellitosis (p < .001). Multivariate analysis revealed age, location, and Breslow depth as significant predictors. Patients ≥75 with lesions 1.01-1.49 mm on the head/neck/upper extremity and 1.5-1.99 mm without high-risk features had <5% risk of SLN positivity. CONCLUSIONS: Intermediate thickness melanoma has significant heterogeneity of SLNB positivity. Low-risk subgroups can be found among older patients in the absence of high-risk features.
BACKGROUND: Guidelines for melanoma recommend sentinel lymph node biopsy (SLNB) in patients with melanomas ≥1 mm thickness. Recent single institution studies have found tumors <1.5 mm a low-risk group for positive SLNB. METHODS: A retrospective review of the Sentinel Lymph Node Working Group multicenter database identified patients with intermediate thickness melanoma (1.01-4.00 mm) who had SLNB, and assessed predictors for positive SLNB. RESULTS: 3460 patients were analyzed, 584 (17%) had a positive SLNB. Univariate factors associated with a positive SLNB included age <60 (p < .001), tumor on the trunk/lower extremity (p < .001), Breslow depth ≥2 mm (p < .001), ulceration (p < .001), mitotic rate ≥1/mm2 (p = .01), and microsatellitosis (p < .001). Multivariate analysis revealed age, location, and Breslow depth as significant predictors. Patients ≥75 with lesions 1.01-1.49 mm on the head/neck/upper extremity and 1.5-1.99 mm without high-risk features had <5% risk of SLN positivity. CONCLUSIONS: Intermediate thickness melanoma has significant heterogeneity of SLNB positivity. Low-risk subgroups can be found among older patients in the absence of high-risk features.
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