BACKGROUND: In the 8th edition of the American Joint Committee on Cancer melanoma staging system, the T1b category has been redefined based solely on thickness and ulceration. National Comprehensive Cancer Network guidelines recommend consideration of sentinel lymph node biopsy (SLNB) for all patients with T1b melanomas (0.8 to 1.0 mm thick). We hypothesized that the new staging system would lead to excessive use of SLNB in patients with non-ulcerated T1b melanomas with a low risk of positive sentinel lymph nodes. STUDY DESIGN: The National Cancer Database 2015 Melanoma Public Use File was used to select patients undergoing SLNB for thin T1 cutaneous melanoma from 2010 to 2015. Clinicopathologic risk factors for having a positive SLNB were evaluated. Univariable and multivariable logistic regression models and classification and regression tree analysis were performed to identify groups with high and low risk of positive SLNB. RESULTS: We selected patients undergoing SLNB without ulceration with thickness 0.75 to 1.04 mm, staged T1b in the new 8th edition American Joint Committee on Cancer by thickness criteria alone (6,894 patients). Independent risk factors for a positive sentinel lymph node were age 56 years or younger (odds ratio [OR] 1.74; 95% CI 1.38 to 2.17), thickness 1.0 vs 0.8 to 0.9 mm (OR 1.36; 95% CI 1.09 to 1.70), female sex (OR 1.36; 95% CI 1.09 to 1.69), and mitotic rate ≥1/mm2 (OR 2.01; 95% CI 1.54 to 2.64). Classification and regression tree analysis identified 2 groups based on age, mitotic rate, and thickness with a risk of positive SLNB <5%. These 2 groups made up 55% of T1b, nonulcerated melanoma patients who underwent SLNB. CONCLUSIONS: The new 8th edition American Joint Committee on Cancer melanoma staging system T1b category should not be used to determine use of SLNB in thin melanoma, as more than one half of T1b lesions without ulceration have a low risk of positive sentinel lymph nodes.
BACKGROUND: In the 8th edition of the American Joint Committee on Cancer melanoma staging system, the T1b category has been redefined based solely on thickness and ulceration. National Comprehensive Cancer Network guidelines recommend consideration of sentinel lymph node biopsy (SLNB) for all patients with T1b melanomas (0.8 to 1.0 mm thick). We hypothesized that the new staging system would lead to excessive use of SLNB in patients with non-ulcerated T1b melanomas with a low risk of positive sentinel lymph nodes. STUDY DESIGN: The National Cancer Database 2015 Melanoma Public Use File was used to select patients undergoing SLNB for thin T1 cutaneous melanoma from 2010 to 2015. Clinicopathologic risk factors for having a positive SLNB were evaluated. Univariable and multivariable logistic regression models and classification and regression tree analysis were performed to identify groups with high and low risk of positive SLNB. RESULTS: We selected patients undergoing SLNB without ulceration with thickness 0.75 to 1.04 mm, staged T1b in the new 8th edition American Joint Committee on Cancer by thickness criteria alone (6,894 patients). Independent risk factors for a positive sentinel lymph node were age 56 years or younger (odds ratio [OR] 1.74; 95% CI 1.38 to 2.17), thickness 1.0 vs 0.8 to 0.9 mm (OR 1.36; 95% CI 1.09 to 1.70), female sex (OR 1.36; 95% CI 1.09 to 1.69), and mitotic rate ≥1/mm2 (OR 2.01; 95% CI 1.54 to 2.64). Classification and regression tree analysis identified 2 groups based on age, mitotic rate, and thickness with a risk of positive SLNB <5%. These 2 groups made up 55% of T1b, nonulcerated melanomapatients who underwent SLNB. CONCLUSIONS: The new 8th edition American Joint Committee on Cancer melanoma staging system T1b category should not be used to determine use of SLNB in thin melanoma, as more than one half of T1b lesions without ulceration have a low risk of positive sentinel lymph nodes.
Authors: Andrea Maurichi; Rosalba Miceli; Hanna Eriksson; Julia Newton-Bishop; Jérémie Nsengimana; May Chan; Andrew J Hayes; Kara Heelan; David Adams; Roberto Patuzzo; Francesco Barretta; Gianfranco Gallino; Catherine Harwood; Daniele Bergamaschi; Dorothy Bennett; Konstantinos Lasithiotakis; Paola Ghiorzo; Bruna Dalmasso; Ausilia Manganoni; Francesca Consoli; Ilaria Mattavelli; Consuelo Barbieri; Andrea Leva; Umberto Cortinovis; Vittoria Espeli; Cristina Mangas; Pietro Quaglino; Simone Ribero; Paolo Broganelli; Giovanni Pellacani; Caterina Longo; Corrado Del Forno; Lorenzo Borgognoni; Serena Sestini; Nicola Pimpinelli; Sara Fortunato; Alessandra Chiarugi; Paolo Nardini; Elena Morittu; Antonio Florita; Mara Cossa; Barbara Valeri; Massimo Milione; Giancarlo Pruneri; Odysseas Zoras; Andrea Anichini; Roberta Mortarini; Mario Santinami Journal: J Clin Oncol Date: 2020-03-13 Impact factor: 44.544
Authors: Richard J B Walker; Nicole J Look Hong; Marc Moncrieff; Alexander C J van Akkooi; Evan Jost; Carolyn Nessim; Winan J van Houdt; Emma H A Stahlie; Chanhee Seo; May Lynn Quan; J Gregory McKinnon; Frances C Wright; Michail N Mavros Journal: Ann Surg Oncol Date: 2022-06-08 Impact factor: 4.339