Predictors of sentinel lymph node metastasis in very thin invasive melanomas.
Publication/Presentation Date
9-15-2023
Abstract
BACKGROUND: Melanomas < 0.8 mm in Breslow depth have less than a 5% risk for nodal positivity. Nonetheless, nodal positivity is prognostic for this group. Early identification of nodal positivity may improve the outcomes for these patients.
OBJECTIVES: To determine the degree to which ulceration and other high-risk features predict sentinel lymph node (SLN) positivity for very thin melanomas.
METHODS: The National Cancer Database was reviewed from 2012 to 2018 for patients with melanoma with Breslow thickness < 0.8 mm. Data were analysed from 7 July 2022 through to 25 February 2023. Patients were excluded if data regarding their ulceration status or SLN biopsy (SLNB) performance were unknown. We analysed patient, tumour and health system factors for their effect on SLN positivity. Data were analysed using χ2 tests and logistic regressions. Overall survival (OS) was compared by Kaplan-Meier analyses.
RESULTS: Positive nodal metastases were seen in 876 (5.0%) patients who underwent SLNB (17 692). Factors significantly associated with nodal positivity on multivariable analysis include lymphovascular invasion [odds ratio (OR) 4.5, P < 0.001], ulceration (OR 2.6, P < 0.001), mitoses (OR 2.1, P < 0.001) and nodular subtype (OR 2.1, P < 0.001). Five-year OS was 75% and 92% for patients with positive and negative SLN, respectively.
CONCLUSIONS: Nodal positivity has prognostic significance for very thin melanomas. In our cohort, the rate of nodal positivity was 5% overall in these patients who underwent SLNB. Specific tumour factors (e.g. lymphovascular invasion, ulceration, mitoses, nodular subtype) were associated with higher rates of SLN metastases and should be used to guide clinicians in choosing which patients will benefit from SLNB.
Volume
189
Issue
4
First Page
419
Last Page
426
ISSN
1365-2133
Published In/Presented At
Kakish, H., Sun, J., Zheng, D. X., Ahmed, F. A., Elshami, M., Loftus, A. W., Ocuin, L. M., Ammori, J. B., Hoehn, R. S., Bordeaux, J. S., & Rothermel, L. D. (2023). Predictors of sentinel lymph node metastasis in very thin invasive melanomas. The British journal of dermatology, 189(4), 419–426. https://doi.org/10.1093/bjd/ljad195
Disciplines
Diagnosis | Medicine and Health Sciences | Other Analytical, Diagnostic and Therapeutic Techniques and Equipment | Radiology
PubMedID
37290803
Department(s)
Department of Surgery, Lehigh Valley Topper Cancer Institute
Document Type
Article
