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Adeuyan O, Gordon ER, Kenchappa D, Bracero Y, Singh A, Espinoza G, Geskin LJ, Saenger YM. An update on methods for detection of prognostic and predictive biomarkers in melanoma. Front Cell Dev Biol 2023; 11:1290696. [PMID: 37900283 PMCID: PMC10611507 DOI: 10.3389/fcell.2023.1290696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/04/2023] [Indexed: 10/31/2023] Open
Abstract
The approval of immunotherapy for stage II-IV melanoma has underscored the need for improved immune-based predictive and prognostic biomarkers. For resectable stage II-III patients, adjuvant immunotherapy has proven clinical benefit, yet many patients experience significant adverse events and may not require therapy. In the metastatic setting, single agent immunotherapy cures many patients but, in some cases, more intensive combination therapies against specific molecular targets are required. Therefore, the establishment of additional biomarkers to determine a patient's disease outcome (i.e., prognostic) or response to treatment (i.e., predictive) is of utmost importance. Multiple methods ranging from gene expression profiling of bulk tissue, to spatial transcriptomics of single cells and artificial intelligence-based image analysis have been utilized to better characterize the immune microenvironment in melanoma to provide novel predictive and prognostic biomarkers. In this review, we will highlight the different techniques currently under investigation for the detection of prognostic and predictive immune biomarkers in melanoma.
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Affiliation(s)
- Oluwaseyi Adeuyan
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Emily R. Gordon
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Divya Kenchappa
- Albert Einstein College of Medicine, Bronx, NY, United States
| | - Yadriel Bracero
- Albert Einstein College of Medicine, Bronx, NY, United States
| | - Ajay Singh
- Albert Einstein College of Medicine, Bronx, NY, United States
| | | | - Larisa J. Geskin
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, United States
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2
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Mohamad I, Glaun MDE, Prabhash K, Busheri A, Lai SY, Noronha V, Hosni A. Current Treatment Strategies and Risk Stratification for Oral Carcinoma. Am Soc Clin Oncol Educ Book 2023; 43:e389810. [PMID: 37200591 DOI: 10.1200/edbk_389810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Management of oral cavity squamous cell carcinoma (OSCC) involves a multidisciplinary team approach. Surgery is ideally the primary treatment option for nonmetastatic OSCC, and less invasive curative surgical approaches are preferred in early-stage disease to minimize surgical-related morbidity. For patients at high risk of recurrence, adjuvant treatment using radiation therapy or chemoradiation is often used. Systemic therapy may also be used in the neoadjuvant setting (for advanced-stage disease with the intent of mandibular preservation) or in the palliative setting (for nonsalvageable locoregional recurrence and/or distant metastases). Patient involvement in treatment decision is the key for patient-driven management, particularly in clinical situation with poor prognosis, for example, early postoperative recurrence before planned adjuvant therapy.
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Affiliation(s)
- Issa Mohamad
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Mica D E Glaun
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Homi Bhabha National Institute, Mumbai, India
| | - Ahmed Busheri
- Department of Radiation Oncology, Kuwait Cancer Control Center, Kuwait
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Homi Bhabha National Institute, Mumbai, India
| | - Ali Hosni
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
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3
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Keung EZ, Krause KJ, Maxwell J, Morris CD, Crago AM, Houdek MT, Kane J, Lewis V, Callegaro D, Miller B, Lazar AJ, Gladdy R, Raut CP, Fabbri N, Al-Refaie W, Fairweather M, Wong SL, Roland CL. Sentinel Lymph Node Biopsy for Extremity and Truncal Soft Tissue Sarcomas: A Systematic Review of the Literature. Ann Surg Oncol 2023; 30:958-967. [PMID: 36307665 DOI: 10.1245/s10434-022-12688-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/04/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Regional lymph node metastasis (RLNM) occurs infrequently in patients with soft tissue sarcoma (STS), although certain STS subtypes have a higher propensity for RLNM. The identification of RLNM has significant implications for staging and prognosis; however, the precise impact of node-positive disease on patient survival remains a topic of controversy. Although the benefits of sentinel lymph node biopsy (SLNB) are well documented in patients with melanoma and breast cancer, whether this procedure offers a benefit in STS is controversial. METHODS A systematic literature search was performed and articles reviewed to determine if SLNB in patients with extremity/truncal STS impacts disease-free or overall survival. RESULTS Six studies were included. Rates of sentinel lymph node positivity were heterogeneous (range 4.3-50%). The impact of SLNB on patient outcomes remains unclear. The overall quality of available evidence was low, as assessed by the Grading of Recommendations, Assessment, Development, and Evaluation system. CONCLUSIONS The literature addressing the impact of nodal basin evaluation on the staging and management of patients with extremity/truncal STS is confounded by heterogeneous patient cohorts and clinical practices. Multicenter prospective studies are warranted to determine the true incidence of RLNM and whether SLNB could benefit patients with clinically occult RLNM at diagnosis.
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Affiliation(s)
- Emily Z Keung
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Kate J Krause
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jessica Maxwell
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carol D Morris
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Aimee M Crago
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - John Kane
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Valerae Lewis
- Department of Orthopedic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dario Callegaro
- Department of Surgery, Sarcoma Service, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Benjamin Miller
- Department of Orthopedic Surgery, University of Iowa, Iowa City, IA, USA
| | - Alexander J Lazar
- Department of Pathology and Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rebecca Gladdy
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Nicola Fabbri
- Department of Orthopedic Surgery, NYU Langone Grossman School of Medicine, New York, NY, USA
| | - Waddah Al-Refaie
- Department of Surgery, Georgetown University Medical Center, Washington, DC, USA
| | - Mark Fairweather
- Department of Surgery, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Sandra L Wong
- Department of Surgery, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Christina L Roland
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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4
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Park J, Park B, Yong U, Ahn J, Kim JY, Kim HH, Jang J, Kim C. Bi-modal near-infrared fluorescence and ultrasound imaging via a transparent ultrasound transducer for sentinel lymph node localization. OPTICS LETTERS 2022; 47:393-396. [PMID: 35030614 DOI: 10.1364/ol.446041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/23/2021] [Indexed: 05/25/2023]
Abstract
Sentinel lymph node biopsy with an indocyanine green-based near-infrared fluorescence imaging system avoids the shortcomings of using a radioisotope or a combination of a blue dye and a radioactive tracer. To improve surgical precision, recent research has provided a depth profile of the sentinel lymph node by fusing fluorescence and ultrasound imaging. Here, we present a combined near-infrared fluorescence and ultrasound imaging system based on a transparent ultrasound transducer. The transparent ultrasound transducer enables seamless coaxial alignment of the fluorescence and ultrasound beam paths, allowing bi-modal observation of a single region of interest. Further, we demonstrate that the sentinel lymph node of mice injected with indocyanine green can be successfully localized and dissected based on information from the bi-modal imaging system.
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Non-Sentinel Lymph Node Detection during Sentinel Lymph Node Biopsy in Not-Complete-Lymph-Node-Dissection Era: A New Technique for Better Staging and Treating Melanoma Patients. J Clin Med 2021; 10:jcm10194319. [PMID: 34640337 PMCID: PMC8509671 DOI: 10.3390/jcm10194319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/09/2021] [Accepted: 09/18/2021] [Indexed: 11/22/2022] Open
Abstract
Sentinel lymph node biopsy has been demonstrated to be an effective staging procedure since its introduction in 1992. The new American Joint Committee on Cancer (AJCC) classification did not consider the lack of information that would result from the less usage of the complete lymph node dissection as for a diagnostic purpose. Thus, this makes it difficult the correct staging and would leave about 20% of the further positive non-sentinel lymph nodes in the lymph node basin. In this paper, we aim to describe a new surgical technique that, combined with single-photon emission computed tomography-computed tomography (SPECT-CT), allows for better staging of melanoma patients. This is a prospective study that includes 104 patients with cutaneous melanoma. Sentinel lymph node biopsy was offered according to the AJCC guideline. Planar lymphoscintigraphy was performed in association with SPECT-CT, identifying and removing all non-biologically “excluded” lymph nodes, guiding the surgeon’s hand in detection and removal of lymph nodes. Even if identification and removal of non-sentinel lymph nodes is unable to increase overall survival, it definitely gives better disease control in the basin. With a “classic” setting, the risk of leaving further lymph nodes out of the sentinel lymph node procedure is around 20%, thus, basically, the surgical sentinel lymph node of first and second lymph nodes would have therapeutic value and complete lymph node dissection classically performed.
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6
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Barriera-Silvestrini P, Iacullo J, Knackstedt TJ. American Joint Committee on Cancer Staging and Other Platforms to Assess Prognosis and Risk. Clin Plast Surg 2021; 48:599-606. [PMID: 34503720 DOI: 10.1016/j.cps.2021.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The eighth edition of the American Joint Committee on Cancer melanoma staging system relies on assessments of the primary tumor (T), regional lymph nodes (N), and distant metastatic sites (M). Its notable updates include tumor thickness measurements to the nearest 0.1 mm, revision of T1a and T1b definitions, re-evaluation of N category descriptors, increased number of stage III subgroupings, and incorporation of a new M1d designation, among others. These changes were based on analyses of a large contemporary international melanoma database. Ultimately, these revisions were made to improve staging and prognostication, risk stratification, and selection of patients for clinical trials.
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Affiliation(s)
| | - Julie Iacullo
- Department of Dermatology, MetroHealth System, 2500 Metrohealth Drive, Cleveland, OH 44109, USA
| | - Thomas J Knackstedt
- Department of Dermatology, MetroHealth System, 2500 Metrohealth Drive, Cleveland, OH 44109, USA; Case Western Reserve University, School of Medicine, Cleveland, OH, USA.
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MacArthur KM, Baumann BC, Sobanko JF, Etzkorn JR, Shin TM, Higgins HW, Giordano CN, McMurray SL, Krausz A, Newman JG, Rajasekaran K, Cannady SB, Brody RM, Karakousis GC, Miura JT, Cohen JV, Amaravadi RK, Mitchell TC, Schuchter LM, Miller CJ. Compliance with sentinel lymph node biopsy guidelines for invasive melanomas treated with Mohs micrographic surgery. Cancer 2021; 127:3591-3598. [PMID: 34292585 DOI: 10.1002/cncr.33651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/30/2021] [Accepted: 04/21/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) has not been studied for invasive melanomas treated with Mohs micrographic surgery using frozen-section MART-1 immunohistochemical stains (MMS-IHC). The primary objective of this study was to assess the accuracy and compliance with National Comprehensive Cancer Network (NCCN) guidelines for SLNB in a cohort of patients who had invasive melanoma treated with MMS-IHC. METHODS This retrospective cohort study included all patients who had primary, invasive, cutaneous melanomas treated with MMS-IHC at a single academic center between March 2006 and April 2018. The primary outcomes were the rates of documenting discussion and performing SLNB in patients who were eligible based on NCCN guidelines. Secondary outcomes were the rate of identifying the sentinel lymph node and the percentage of positive lymph nodes. RESULTS In total, 667 primary, invasive, cutaneous melanomas (American Joint Committee on Cancer T1a-T4b) were treated with MMS-IHC. The median patient age was 69 years (range, 25-101 years). Ninety-two percent of tumors were located on specialty sites (head and/or neck, hands and/or feet, pretibial leg). Discussion of SLNB was documented for 162 of 176 (92%) SLNB-eligible patients, including 127 of 127 (100%) who had melanomas with a Breslow depth >1 mm. SLNB was performed in 109 of 176 (62%) SLNB-eligible patients, including 102 of 158 melanomas (65%) that met NCCN criteria to discuss and offer SLNB and 7 of 18 melanomas (39%) that met criteria to discuss and consider SLNB. The sentinel lymph node was successfully identified in 98 of 109 patients (90%) and was positive in 6 of those 98 patients (6%). CONCLUSIONS Combining SLNB and MMS-IHC allows full pathologic staging and confirmation of clear microscopic margins before reconstruction of specialty site invasive melanomas. SLNB can be performed accurately and in compliance with consensus guidelines in patients with melanoma using MMS-IHC.
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Affiliation(s)
| | - Brian C Baumann
- Department of Radiation Oncology, Washington University, St Louis, Missouri
| | - Joseph F Sobanko
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Jeremy R Etzkorn
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Thuzar M Shin
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - H William Higgins
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Cerrene N Giordano
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Stacy L McMurray
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Aimee Krausz
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Jason G Newman
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Steven B Cannady
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Robert M Brody
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Giorgos C Karakousis
- Division of Endocrine and Oncologic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - John T Miura
- Division of Endocrine and Oncologic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Justine V Cohen
- Division of Hematology Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Ravi K Amaravadi
- Division of Hematology Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Tara C Mitchell
- Division of Hematology Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Lynn M Schuchter
- Division of Hematology Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Christopher J Miller
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
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In-depth proteomics analysis of sentinel lymph nodes from individuals with endometrial cancer. CELL REPORTS MEDICINE 2021; 2:100318. [PMID: 34195683 PMCID: PMC8233695 DOI: 10.1016/j.xcrm.2021.100318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/17/2020] [Accepted: 05/20/2021] [Indexed: 12/18/2022]
Abstract
Endometrial cancer (EC) is one of the most common gynecological cancers worldwide. Sentinel lymph node (SLN) status could be a major prognostic factor in evaluation of EC, but several prospective studies need to be performed. Here we report an in-depth proteomics analysis showing significant variations in the SLN protein landscape in EC. We show that SLNs are correlated to each tumor grade, which strengthens evidence of SLN involvement in EC. A few proteins are overexpressed specifically at each EC tumor grade and in the corresponding SLN. These proteins, which are significantly variable in both locations, should be considered potential markers of overall survival. Five major proteins for EC and SLN (PRSS3, PTX3, ASS1, ALDH2, and ANXA1) were identified in large-scale proteomics and validated by immunohistochemistry. This study improves stratification and diagnosis of individuals with EC as a result of proteomics profiling of SLNs.
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Predictors of Nonsentinel Lymph Node Metastasis in Cutaneous Melanoma: A Systematic Review and Meta-Analysis. J Surg Res 2020; 260:506-515. [PMID: 33358194 DOI: 10.1016/j.jss.2020.11.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/05/2020] [Accepted: 11/01/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Although completion lymph node dissection (CLND) is not routinely performed for a positive sentinel lymph node (SLN) anymore, adjuvant therapy depends on the risk factors available from SLN biopsy, including the risk of nonsentinel node metastases (NSNM). A systematic review and meta-analysis was performed in an attempt to identify risk factors that could be used to predict the risk of NSNM. MATERIALS AND METHODS Medline, Web of Science, Embase, and Cochrane were searched for articles discussing predictive factors for NSNM. PRISMA guidelines were followed, and RevMan software was used to calculate pooled odds ratios (OR) using the Mantel-Haenszel test. RESULTS Fifty publications were suitable for additional analysis. The clinical and primary tumor factors that were consistently identified as risk factors for NSNMs were: age >50, T stage 3 or 4, Clark level IV/V, ulceration, microsatellitosis, lymphovascular invasion, nodular histology, and extremity versus trunk primary tumor location. SLN factors that predicted NSNMs were >1 positive SLN, SLN micrometastatic tumor burden, diameter >2 mm, extracapsular extension, nonsubcapsular location (Dewar), and Rotterdam > 1 mm or ≥ 0.1 mm. CONCLUSIONS The findings in this study support that many clinical and pathologic risk factors that can be assessed with SLN biopsy alone can be used to predict the risk of NSNMs. The factors identified in this review should be evaluated in clinical prediction models to predict the risk of NSNMS, a prediction that may be used to select patients for adjuvant therapy in high-risk melanoma.
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Ravichandran S, Nath N, Jones DC, Li G, Suresh V, Brys AK, Hanks BA, Beasley GM, Salama AKS, Howard BA, Mosca PJ. The utility of initial staging PET-CT as a baseline scan for surveillance imaging in stage II and III melanoma. Surg Oncol 2020; 35:533-539. [PMID: 33161362 DOI: 10.1016/j.suronc.2020.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/11/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND This study evaluates the utility of whole-body PET-CT for the initial staging and subsequent surveillance imaging of patients with completely resected stage II and stage III melanoma. METHODS A single-center, retrospective review of patients who received perioperative whole-body PET-CT from January 1, 2005 to December 1, 2019 within three months of initial melanoma diagnosis was performed. RESULTS Of 258 total patients with completely resected melanoma who had a PET-CT within 3 months after their melanoma diagnosis, 113 had stage II and 145 had stage III melanoma. PET-CT detected distant metastasis in 3 (2.7%) of 113 stage II patients and 7 (4.8%) of 145 stage III patients. 179 of 258 patients had adequate follow-up time to determine whether they received surveillance cross-sectional imaging and whether they had a melanoma recurrence. 143 (79.9%) received subsequent surveillance imaging, 74 of whom developed a recurrence. In 64 (86.5%) of 74 cases, recurrence was detected by routine surveillance. 26 (34.2%) of 76 stage II and 65 (63.1%) of 103 stage III patients developed a recurrence. The median time to recurrence among the 179 patients for stage II and III was 16.3 and 13.0 months, respectively. CONCLUSIONS These findings indicate that baseline staging with whole-body PET-CT rarely provides information that changes initial management. Rather, the value of the initial PET-CT is as a baseline for subsequent surveillance scans. Therefore, it may be premature to discourage cross-sectional imaging for patients with stage II and III melanoma without supportive evidence or a reliable biomarker of recurrent disease.
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Affiliation(s)
- Surya Ravichandran
- Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Neel Nath
- Department of Dermatology, Duke University Medical Center, Durham, NC, USA
| | - David C Jones
- Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Gabriel Li
- Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Visakha Suresh
- Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Adam K Brys
- Department of Dermatology, Duke University Medical Center, Durham, NC, USA
| | - Brent A Hanks
- Department of Medicine, Division of Medical Oncology and Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC, USA
| | - Georgia M Beasley
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - April K S Salama
- Department of Medicine, Division of Medical Oncology and Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC, USA
| | - Brandon A Howard
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Paul J Mosca
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
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Kang HJ, Choi ME, Won CH, Chang SE, Lee MW, Choi JH, Lee WJ. Clinicoprognostic characteristics of cutaneous metastatic melanoma: a retrospective comparative study between acral and nonacral melanoma. Int J Dermatol 2020; 59:1249-1257. [DOI: 10.1111/ijd.15066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/11/2020] [Accepted: 06/18/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Hyun Ji Kang
- Department of Dermatology Veterans health service medical center Seoul Korea
| | - Myoung Eun Choi
- Department of Dermatology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Chong Hyun Won
- Department of Dermatology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Sung Eun Chang
- Department of Dermatology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Mi Woo Lee
- Department of Dermatology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Jee Ho Choi
- Department of Dermatology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Woo Jin Lee
- Department of Dermatology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
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12
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Keung EZ, Gershenwald JE. Clinicopathological Features, Staging, and Current Approaches to Treatment in High-Risk Resectable Melanoma. J Natl Cancer Inst 2020; 112:875-885. [PMID: 32061122 PMCID: PMC7492771 DOI: 10.1093/jnci/djaa012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/06/2019] [Accepted: 01/17/2020] [Indexed: 12/12/2022] Open
Abstract
The incidence of melanoma in the United States has been increasing over the past several decades. Prognosis largely depends on disease stage, with 5-year melanoma-specific survival ranging from as high as 99% in patients with stage I disease to less than 10% for some patients with stage IV (distant metastatic) disease. Fortunately, in the last 5-10 years, there have been remarkable treatment advances for patients with high-risk resectable melanoma, including approval of targeted and immune checkpoint blockade therapies. In addition, results of recent clinical trials have confirmed the importance of sentinel lymph node biopsy and continue to refine the approach to regional lymph node basin management. Lastly, the melanoma staging system was revised in the eighth edition AJCC Cancer Staging Manual, which was implemented on January 1, 2018. Here we discuss these changes and the clinicopathological features that confer high risk for locoregional and distant disease relapse and poor survival. Implications regarding the management of melanoma in the metastatic and adjuvant settings are discussed, as are future directions for neoadjuvant therapies.
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Affiliation(s)
- Emily Z Keung
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Melanoma and Skin Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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13
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de Carvalho CEB, Capuzzo R, Crovador C, Teixeira RJ, Laus AC, Carvalho AL, Vazquez VL. Near Infrared (NIR) Fluorescence is Not a Substitute for Lymphoscintigraphy and Gamma Probe for Melanoma Sentinel Node Detection: Results from a Prospective Trial. Ann Surg Oncol 2020; 27:2906-2912. [DOI: 10.1245/s10434-020-08409-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Indexed: 12/26/2022]
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14
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Hanks JE, Kovatch KJ, Ali SA, Roberts E, Durham AB, Smith JD, Bradford CR, Malloy KM, Boonstra PS, Lao CD, McLean SA. Sentinel Lymph Node Biopsy in Head and Neck Melanoma: Long-term Outcomes, Prognostic Value, Accuracy, and Safety. Otolaryngol Head Neck Surg 2020; 162:520-529. [PMID: 32041486 DOI: 10.1177/0194599819899934] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the long-term outcomes of sentinel lymph node biopsy (SLNB) for head and neck cutaneous melanoma (HNCM). STUDY DESIGN Retrospective cohort study. SETTING Tertiary academic medical center. SUBJECTS AND METHODS Longitudinal review of a 356-patient cohort with HNCM undergoing SLNB from 1997 to 2007. RESULTS Descriptive characteristics included the following: age, 53.5 ± 19 years (mean ± SD); sex, 26.8% female; median follow-up, 4.9 years; and Breslow depth, 2.52 ± 1.87 mm. Overall, 75 (21.1%) patients had a positive SLNB. Among patients undergoing completion lymph node dissection following positive SLNB, 20 (27.4%) had at least 1 additional positive nonsentinel lymph node. Eighteen patients with local control and negative SLNB developed regional disease, indicating a false omission rate of 6.4%, including 10 recurrences in previously unsampled basins. Ten-year overall survival (OS) and melanoma-specific survival (MSS) were significantly greater in the negative sentinel lymph node (SLN) cohort (OS, 61% [95% CI, 0.549-0.677]; MSS, 81.9% [95% CI, 0.769-0.873]) than the positive SLN cohort (OS, 31% [95% CI, 0.162-0.677]; MSS, 60.3% [95% CI, 0.464-0.785]) and positive SLN/positive nonsentinel lymph node cohort (OS, 8.4% [95% CI, 0.015-0.474]; MSS, 9.6% [95% CI, 0.017-0.536]). OS was significantly associated with SLN positivity (hazard ratio [HR], 2.39; P < .01), immunosuppression (HR, 2.37; P < .01), angiolymphatic invasion (HR, 1.91; P < .01), and ulceration (HR, 1.86; P < .01). SLN positivity (HR, 3.13; P < .01), angiolymphatic invasion (HR, 3.19; P < .01), and number of mitoses (P = .0002) were significantly associated with MSS. Immunosuppression (HR, 3.01; P < .01) and SLN status (HR, 2.84; P < .01) were associated with recurrence-free survival, and immunosuppression was the only factor significantly associated with regional recurrence (HR, 6.59; P < .01). CONCLUSIONS Long-term follow up indicates that SLNB showcases durable accuracy, safety, and prognostic importance for cutaneous HNCM.
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Affiliation(s)
- John E Hanks
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Kevin J Kovatch
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - S Ahmed Ali
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Emily Roberts
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Alison B Durham
- Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Joshua D Smith
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA.,University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Philip S Boonstra
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Christopher D Lao
- Department of Medical Oncology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Scott A McLean
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
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Abstract
PURPOSE OF REVIEW This review describes the long scientific background followed to design guidelines and everyday clinical practice applied to melanoma patients. Surgery is the first option to cure melanoma patients (PTS) at initial diagnosis, since primary cutaneous lesions are usually easily resectable. An excisional biopsy of the lesion, with minimal clear margins, can be obtained in the vast majority of cases. Punch biopsies may be proposed only in case of large lesions located on specific cosmetic or functional areas like the face, extremities, or genitals where a mutilating complete resection would not be performed without prior histological diagnosis. RECENT FINDINGS After the histologic confirmation of melanoma, definite surgical excision of the scar and surrounding tissue is planned, to obtain microsatellite free margins. The width of these margins has been identified following the results of several clinical trials and it is either 1 or 2 cm, depending on the Breslow thickness of the primary tumor. Following the latest staging system proposed by the American Joint Cancer commission (AJCC), a sentinel node biopsy (SNB) is usually performed in case of a primary lesion > 0.8 mm thickness or for high-risk thinner lesions, if no evidence of nodal involvement has been identified clinically or radiographically. Surgical management of primary melanoma is well established. There is debate on the optimal surgical margins for 1-2 mm melanomas. There are specific considerations for special primaries (bulky, extremity, mucosal). Sentinel node (SN) evaluation does not improve survival, but is routinely used as staging.
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Affiliation(s)
- Alessandro A E Testori
- Dermatology, Fondazione IRCCS policlinico San Matteo, Fondazione IRCCS San Matteo, Pavia, Italy.
| | - Stephanie A Blankenstein
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Alexander C J van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, Netherlands
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Rawson RV, Scolyer RA. From Breslow to BRAF and immunotherapy: evolving concepts in melanoma pathogenesis and disease progression and their implications for changing management over the last 50 years. Hum Pathol 2019; 95:149-160. [PMID: 31704364 DOI: 10.1016/j.humpath.2019.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 02/03/2023]
Abstract
Since it was first recognized as a disease entity more than two centuries ago, advanced melanoma has, until recently, followed a very aggressive and almost universally fatal clinical course. However, over the past 50 years crucial ground breaking research has greatly enhanced our understanding of the etiology, risk factors, genomic pathogenesis, immunological interactions, prognostic features and management of melanoma. It is this combined body of work which has culminated in the exciting improvements in patient outcomes for those with advanced melanoma over the last ten years. In this the 50th anniversary of Human Pathology, we highlight the key developments in melanoma over this period.
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Affiliation(s)
- Robert V Rawson
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, 2020, NSW, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; New South Wales Health Pathology, Camperdown 2050, NSW, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, 2020, NSW, Australia.
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17
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Cecchi R, De Gaudio C, Buralli L, Innocenti S. Lymphatic Mapping and Sentinel Lymph Node Biopsy in the Management of Primary Cutaneous Melanoma: Report of a Single-centre Experience. TUMORI JOURNAL 2019; 92:113-7. [PMID: 16724689 DOI: 10.1177/030089160609200205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Aims and Background Lymphatic mapping and sentinel lymph node biopsy provide important prognostic data in patients with early stage melanoma and are crucial in guiding the management of the tumor. We report our experience with lymphatic mapping and sentinel lymph node biopsy in a group of patients with primary cutaneous melanoma and discuss recent concepts and controversies on its use. Patients and Methods A total of 111 patients with stage I-II AJCC primary cutaneous melanoma underwent lymphatic mapping and sentinel lymph node biopsy from December 1999 through December 2004 using a standardized technique of preoperative lymphoscintigraphy and biopsy guided by blue dye injection in addition to a hand-held gamma probe. After removal, sentinel lymph nodes were submitted to serial sectioning and permanent preparations for histological and immunohistochemical examination. Complete lymph node dissection was performed only in patients with tumor-positive sentinel lymph nodes. Results Sentinel lymph nodes were identified and removed in all patients (detection rate of 100%), and metastases were found in 17 cases (15.3%). The incidence of metastasis in sentinel lymph nodes was 2.1%, 15.9%, 35.2%, and 41.6% for melanomas < or 1.0, 1.01-2.0, 2.01-4.0, and > 4.0 mm in thickness, respectively. Complete lymph node dissection was performed in 15 of 17 patients with positive sentinel lymph nodes, and metastases in non-sentinel lymph nodes were detected in only 2 cases (11.7%). Recurrences were more frequently observed in patients with a positive than in those with negative sentinel lymph node (41.1% vs 5.3% at a median follow-up of 31.5 months, P<0.001). The false-negative rate was 2.1%. Conclusions Our study confirms that lymphatic mapping and sentinel lymph node biopsy allow accurate staging and yield relevant prognostic information in patients with early stage melanoma.
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Affiliation(s)
- Roberto Cecchi
- Cutaneous Surgery Service, Pistoia Hospital, Pistoia, Italy.
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18
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El Sharouni MA, Witkamp AJ, Sigurdsson V, van Diest PJ. Probability of sentinel lymph node positivity in melanoma. Eur J Cancer 2019; 116:10-12. [DOI: 10.1016/j.ejca.2019.04.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 04/27/2019] [Indexed: 11/30/2022]
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19
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Güney İB, Küçüker KA. Cilt kanserlerinde lenfosintigrafi ve cerrahi gama prob ile sentinel lenf nodu biyopsisinin minimal invaziv cerrahi yaklaşımındaki rolü. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.411652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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20
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Small and Isolated Immunohistochemistry-positive Cells in Melanoma Sentinel Lymph Nodes Are Associated With Disease-specific and Recurrence-free Survival Comparable to that of Sentinel Lymph Nodes Negative for Melanoma. Am J Surg Pathol 2019; 43:755-765. [DOI: 10.1097/pas.0000000000001229] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Keung EZ, Gershenwald JE. The eighth edition American Joint Committee on Cancer (AJCC) melanoma staging system: implications for melanoma treatment and care. Expert Rev Anticancer Ther 2019; 18:775-784. [PMID: 29923435 DOI: 10.1080/14737140.2018.1489246] [Citation(s) in RCA: 251] [Impact Index Per Article: 50.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The eighth edition of the American Joint Committee on Cancer (AJCC) melanoma staging system was implemented in the United States on 1 January 2018. Areas covered: This article provides an overview of important changes in the eighth edition AJCC staging system from the seventh edition based on analyses of a large international melanoma database. The clinical implications of these changes for melanoma treatment are also discussed. Expert commentary: A standardized and contemporary cancer staging system that facilitates accurate risk stratification is essential to guide patient treatment. The eighth edition of the AJCC staging system is currently the most widely accepted approach to melanoma staging and classification at initial diagnosis.
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Affiliation(s)
- Emily Z Keung
- a Department of Surgical Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Jeffrey E Gershenwald
- a Department of Surgical Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA.,b Melanoma and Skin Center , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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22
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Parikh PP, Tashiro J, Rubio GA, Sola JE, Neville HL, Hogan AR, Perez EA. Incidence and outcomes of pediatric extremity melanoma: A propensity score matched SEER study. J Pediatr Surg 2018; 53:1753-1760. [PMID: 29602554 DOI: 10.1016/j.jpedsurg.2018.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 02/19/2018] [Accepted: 03/04/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a paucity of literature on treatment of melanoma in children with surgical management extrapolated from adult experience. The incidence and clinical outcomes of pediatric extremity melanoma were studied. METHODS SEER registry was analyzed between 1973 and 2010 for patients <20years old with extremity melanoma. Multivariate and propensity-score matched analyses were performed to identify independent predictors of survival. RESULTS Overall, 917 patients were identified with an age-adjusted incidence of 0.2/100,000 persons, annual percent change 0.96. Most had localized disease (77%), histology revealing melanoma-not otherwise specified (52%). Surgical procedures performed included wide local excision (50%), excisional biopsy (32%), lymphadenectomy (LA) (28%), and sentinel lymph node biopsy (SLNB) (15%). Overall, 30-year disease specific mortality was 7% with lower survival for extremity melanoma (90%), males (89%), nodular histology (69%), and distant disease (36%) (all P<0.05). Post-treatment multivariate analysis revealed localized disease (HR 9.76; P=0.006) as an independent prognosticator of survival; earlier diagnostic years 1988-1999 (HR 2.606; P=0.017) were a negative prognosticator of survival. Propensity-score matched analysis found no difference in survival between SLNB/LA vs no sampling for regional/distant disease. CONCLUSIONS Pediatric extremity melanoma in SEER demonstrate no survival advantage between children undergoing sampling procedures vs no sampling for regional/distant disease. TYPE OF STUDY Retrospective, prognostic study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Punam P Parikh
- DeWitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida.
| | - Jun Tashiro
- DeWitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Gustavo A Rubio
- DeWitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Juan E Sola
- DeWitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Holly L Neville
- DeWitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Anthony R Hogan
- DeWitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Eduardo A Perez
- DeWitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
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23
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Pow SY, Teo M. Unusual presentation of primary cutaneous melanoma of the forearm with epitrochlear and axillary lymphadenopathy. BMJ Case Rep 2018; 2018:bcr-2017-222518. [PMID: 29866664 DOI: 10.1136/bcr-2017-222518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In patients with primary cutaneous melanomas of the distal upper limb, metastatic involvement of the epitrochlear lymph nodes is uncommon. It belongs to a particular category of nodal metastasis termed as interval or in-transit lymphadenopathies often encountered by tumour cells as they spread from the primary sites. We describe the case of a 41-year-old woman who presented with a right forearm melanoma that was metastatic to both the epitrochlear and axillary lymph nodes. She underwent wide excision of the primary lesion as well as epitrochlear and axillary nodal clearances in the same sitting. Although uncommon, It is prudent to search for the presence of sentinel lymph nodes in the epitrochlear region although uncommon, and where positive, a completion axillary clearance should be undertaken at the same time as the epitrochlear clearance. Failure to detect the presence of interval lymph nodes along the melanoma spread pathways may be a cause of tumour recurrence.
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Affiliation(s)
- Siok Yen Pow
- Department of General Surgery, Singapore General Hospital, Singapore
| | - Melissa Teo
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore
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24
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Balch CM. Detection of melanoma metastases with the sentinel node biopsy: the legacy of Donald L. Morton, MD (1934-2014). Clin Exp Metastasis 2018; 35:425-429. [PMID: 29855858 DOI: 10.1007/s10585-018-9908-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 05/29/2018] [Indexed: 01/07/2023]
Abstract
Dr. Donald L. Morton was clearly the pioneer of the sentinel node biopsy, which was a major advance in oncology that has improved the management of cancer patients worldwide. He conducted a series of practice-changing clinical trials to validate the important staging role of the sentinel lymph node biopsy for melanoma, and also spawned other studies that demonstrated its staging value in multiple other cancer types, most notably in breast cancer, gastric cancer, and colorectal cancer. His many contributions in this field have provided a unique opportunity to study host/tumor relationships, since the sentinel lymph node is the first location were the host immune defenses are confronted with metastasis arising from the primary cancer.
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Affiliation(s)
- Charles M Balch
- University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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25
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Cafiero F, Gipponi M, Di Somma C, Solari N, Peressini A, Gliori S, Bassetti C, Spina B, Nicolò G, Schenone F, Castagnola F, Queirolo P, Sertoli MR. The Role of Sentinel Lymph Node Biopsy in Patients with Stage I/Ii Cutaneous Melanoma. The Clinical Experience at the National Cancer Research Institute of Genoa, Italy. TUMORI JOURNAL 2018; 88:S55-6. [PMID: 12369556 DOI: 10.1177/030089160208800347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- F Cafiero
- SC Oncologia Chirurgica Ospedale Voltri ASL3, Genoa, Italy.
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26
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Affiliation(s)
- Charles M Balen
- Departments of Surgery and Oncology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- WHO Melanoma Program, Milano, Italy
| | - Natale Cascinelli
- Istituto Nazionale Tumori, Milano, Italy
- WHO Melanoma Program, Milano, Italy
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27
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Brandão PHDM, Bertolli E, Doria-Filho E, Santos Filho IDAO, de Macedo MP, Pinto CAL, Duprat Neto JP. In transit sentinel node drainage as a prognostic factor for patients with cutaneous melanoma. J Surg Oncol 2018; 117:864-867. [PMID: 29484669 DOI: 10.1002/jso.25023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/26/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Minor basin or in transit node drainage can be found in patients with cutaneous melanoma who undergo sentinel node biopsy. Its clinical impact is still unclear. Our objective is to evaluate clinical outcomes in patients who presented with in transit sentinel node (ITN) drainage. MATERIAL AND METHODS Retrospective analysis of patients who underwent sentinel node biopsy (SNB) in a single Brazilian institution between 2000 and 2015. RESULTS Our cohort comprised 1223 SNB. There were 64 patients (5.2%) with ITN. Melanoma of the limbs (OR 10.61, P < 0.0001) and acral subtype (OR 3.49, P < 0.0001) were associated with ITN drainage. Among these 64 patients, 14 (21.9%) had a positive SNB. The ITN was positive for metastases in five patients, four in a popliteal basin and one on the trunk. Regarding completion node dissection (CND), two patients had positive non-sentinel nodes (NSN), both in major basins. In patients who developed recurrence, time to recurrence was shorter (mean time 18 vs 31.4 months, P = 0.001) and time to death was shorter (mean time 31.6 vs 40 months, P = 0.039) in those who had ITN drainage. CONCLUSION ITN drainage was associated with earlier recurrences and deaths from melanoma.
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Affiliation(s)
- Paulo H D M Brandão
- Surgical Oncology Medical Residence Program, AC Camargo Cancer Center, São Paulo, Brazil
| | - Eduardo Bertolli
- Skin Cancer Department, AC Camargo Cancer Center, São Paulo, Brazil
| | - Eduardo Doria-Filho
- Surgical Oncology Medical Residence Program, AC Camargo Cancer Center, São Paulo, Brazil
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Alessi C, Scapulatempo Neto C, Viana CR, Vazquez VDL. PD-1/PD-L1 and VEGF-A/VEGF-C expression in lymph node microenvironment and association with melanoma metastasis and survival. Melanoma Res 2017; 27:565-572. [PMID: 28984690 DOI: 10.1097/cmr.0000000000000396] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Regional lymph nodes are affected frequently by melanoma metastasis. Its microenvironment may be associated with tumor progression. We investigated sentinel nodes with and without tumor and negative nodes surrounding positive nodes, looking for patterns related to tumor immune interaction and lymphovascular progression. We quantified programmed cell death protein 1 (PD-1)/programmed cell death-ligand 1, vascular endothelial growth factor (VEGF)-A/VEGF-C expressions in lymph nodes of 103 patients who underwent sentinel lymph node biopsy. Two groups were studied: negative sentinel lymph nodes and positive ones. Negative lymph nodes of sequential lymphadenectomy from positive cases were also studied. Markers were assessed by immunohistochemistry. Results were related to clinical/histological outcomes. VEGF-A/VEGF-C analysis showed higher positivity in metastatic nodes and higher positivity in the surrounding negative nodes from positive cases in comparison with nonmetastatic patients. Programmed cell death-ligand 1, studied only in metastasis, presented high positivity, not associated with prognosis. PD-1 expressions were similar in the groups with a 1% cutoff and higher in the metastasis with a 5% cutoff. Higher VEGF-A expression was related to higher pathological stages. PD-1 expression in the lymph node was associated with higher survival. Other clinical and histopatological variables were not associated with marker expression patterns. VEGF-A and VEGF-C expressions in lymph nodes were associated with the presence of lymph node metastasis. PD-1 expression in the lymph node was related to higher survival rates and this should be explored in the context of adjuvant immunotherapy.
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Affiliation(s)
- Cristina Alessi
- aDepartment of Dermatology in Medical Clinic 'Alessi e Rocha' and Medical Specialists Ambulatories of Barretos bIEP/CEPOM - Research Institute and Molecular Oncology Research Center cDepartment of Surgery - Melanoma and Sarcoma, Barretos Cancer Hospital, Barretos dDepartment of Pathology of Laboratório Bacchi, Botucatu, São Paulo ePathology Service, Américas Centro Oncológico Integrado, Rio de Janeiro, Brazil
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29
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Gershenwald JE, Scolyer RA, Hess KR, Sondak VK, Long GV, Ross MI, Lazar AJ, Faries MB, Kirkwood JM, McArthur GA, Haydu LE, Eggermont AMM, Flaherty KT, Balch CM, Thompson JF. Melanoma staging: Evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin 2017; 67:472-492. [PMID: 29028110 PMCID: PMC5978683 DOI: 10.3322/caac.21409] [Citation(s) in RCA: 1429] [Impact Index Per Article: 204.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/09/2017] [Accepted: 08/10/2017] [Indexed: 02/06/2023] Open
Abstract
Answer questions and earn CME/CNE To update the melanoma staging system of the American Joint Committee on Cancer (AJCC) a large database was assembled comprising >46,000 patients from 10 centers worldwide with stages I, II, and III melanoma diagnosed since 1998. Based on analyses of this new database, the existing seventh edition AJCC stage IV database, and contemporary clinical trial data, the AJCC Melanoma Expert Panel introduced several important changes to the Tumor, Nodes, Metastasis (TNM) classification and stage grouping criteria. Key changes in the eighth edition AJCC Cancer Staging Manual include: 1) tumor thickness measurements to be recorded to the nearest 0.1 mm, not 0.01 mm; 2) definitions of T1a and T1b are revised (T1a, <0.8 mm without ulceration; T1b, 0.8-1.0 mm with or without ulceration or <0.8 mm with ulceration), with mitotic rate no longer a T category criterion; 3) pathological (but not clinical) stage IA is revised to include T1b N0 M0 (formerly pathologic stage IB); 4) the N category descriptors "microscopic" and "macroscopic" for regional node metastasis are redefined as "clinically occult" and "clinically apparent"; 5) prognostic stage III groupings are based on N category criteria and T category criteria (ie, primary tumor thickness and ulceration) and increased from 3 to 4 subgroups (stages IIIA-IIID); 6) definitions of N subcategories are revised, with the presence of microsatellites, satellites, or in-transit metastases now categorized as N1c, N2c, or N3c based on the number of tumor-involved regional lymph nodes, if any; 7) descriptors are added to each M1 subcategory designation for lactate dehydrogenase (LDH) level (LDH elevation no longer upstages to M1c); and 8) a new M1d designation is added for central nervous system metastases. This evidence-based revision of the AJCC melanoma staging system will guide patient treatment, provide better prognostic estimates, and refine stratification of patients entering clinical trials. CA Cancer J Clin 2017;67:472-492. © 2017 American Cancer Society.
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Affiliation(s)
- Jeffrey E. Gershenwald
- Professor of Surgery and Cancer Biology, Department of Surgical Oncology; Medical Director, Melanoma and Skin Center, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Richard A. Scolyer
- Conjoint Medical Director, Melanoma Institute Australia; Clinical Professor, The University of Sydney, Sydney, New South Wales, Australia
- Senior Staff Pathologist, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kenneth R. Hess
- Professor, Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vernon K. Sondak
- Chair, Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL
| | - Georgina V. Long
- Conjoint Medical Director and Chair of Melanoma Medical Oncology and Translational Research, Melanoma Institute Australia, The University of Sydney and Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Merrick I. Ross
- Professor of Surgery, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alexander J. Lazar
- Professor of Pathology, Dermatology, and Translational Molecular Pathology; Director, Melanoma Molecular Diagnostics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mark B. Faries
- Co-Director, Melanoma Program; Head, Surgical Oncology, The Angeles Clinic and Research Institute, Los Angeles, CA
| | - John M. Kirkwood
- Professor of Medicine, Dermatology, and Translational Science, The University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Grant A. McArthur
- Executive Director, Victorian Comprehensive Cancer Center, Melbourne, Victoria, Australia
| | - Lauren E. Haydu
- Manager, Clinical Data Management Systems, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Keith T. Flaherty
- Director, Termeer Center for Targeted Therapy, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Charles M. Balch
- Professor of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - John F. Thompson
- Professor of Melanoma and Surgical Oncology, Melanoma Institute Australia, The University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Joyce KM, McInerney NM, Piggott RP, Martin F, Jones DM, Hussey AJ, Kerin MJ, Kelly JL, Regan PJ. Analysis of sentinel node positivity in primary cutaneous melanoma: an 8-year single institution experience. Ir J Med Sci 2017; 186:847-853. [PMID: 28132159 DOI: 10.1007/s11845-017-1559-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 01/11/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) is a standard method for determining the pathologic status of the regional lymph nodes. AIMS The aim of our study was to determine the incidence and clinicopathologic factors predictive of SLN positivity, and to evaluate the prognostic importance of SLNB in patients with cutaneous melanoma. METHODS We performed a retrospective analysis of a prospectively maintained database of all patients who underwent SLNB for primary melanoma at our institution from 2005 to 2012. Statistical analysis was performed using χ 2 and Fischer exact test. RESULTS In total, 318 patients underwent SLNB, of which 65 were for thin melanoma (≤1 mm). There were 36 positive SLNB, 278 negative SLNB and in four cases the SLN was not located. The incidence rate for SLNB was 11.3% overall and 1.5% in thin melanomas alone. Statistical analysis identified Breslow thickness >1 mm (P = 0.006), Clark level ≥ IV (P = 0.004) and age <75 years (P = 0.035) as the strongest predictors of SLN positivity. Our overall false negativity rate was 20% (9/45) with one case of false-negative SLNB in thin melanomas. CONCLUSION Breslow thickness of the primary tumour remains the strongest predictor of SLN positivity. Our findings point to a possible limited role for SLNB in thin melanoma due to its low positivity rate, associated false-negative rate and related morbidity.
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Affiliation(s)
- K M Joyce
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland.
| | - N M McInerney
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland
| | - R P Piggott
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland
| | - F Martin
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland
| | - D M Jones
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland
| | - A J Hussey
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland
| | - M J Kerin
- Department of Surgery, Clinical Science Institute, Galway University Hospital, Galway, Ireland
| | - J L Kelly
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland
| | - P J Regan
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland
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Garganese G, Collarino A, Fragomeni S, Rufini V, Perotti G, Gentileschi S, Evangelista M, Ieria F, Zagaria L, Bove S, Giordano A, Scambia G. Groin sentinel node biopsy and 18F-FDG PET/CT-supported preoperative lymph node assessment in cN0 patients with vulvar cancer currently unfit for minimally invasive inguinal surgery: The GroSNaPET study. Eur J Surg Oncol 2017; 43:1776-1783. [DOI: 10.1016/j.ejso.2017.06.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 06/01/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022] Open
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Cusimano MC, Walker R, Bernardini MQ, Bouchard-Fortier G, Laframboise S, May T, Murphy J, Rosen B, Covens A, Clarke B, Shaw P, Rouzbahman M, Mohan R, Ferguson SE. Implementing a Cervical Sentinel Lymph Node Biopsy Program: Quality Improvement in Gynaecologic Oncology. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:659-667. [DOI: 10.1016/j.jogc.2017.02.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/14/2017] [Accepted: 02/15/2017] [Indexed: 10/19/2022]
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Cordeiro E, Gervais MK, Shah PS, Look Hong NJ, Wright FC. Sentinel Lymph Node Biopsy in Thin Cutaneous Melanoma: A Systematic Review and Meta-Analysis. Ann Surg Oncol 2016; 23:4178-4188. [PMID: 26932710 DOI: 10.1245/s10434-016-5137-z] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Most patients with melanoma have a thin (≤1.00 mm) lesion. There is uncertainty as to which patients with thin melanoma should undergo sentinel lymph node (SN) biopsy. We sought to quantify the proportion of SN metastases in patients with thin melanoma and to determine the pooled effect of high-risk features of the primary lesion on SN positivity. METHODS Published literature between 1980 and 2015 was searched and critically appraised. Primary outcome was the proportion of SN metastases in patients with thin cutaneous melanoma. Secondary outcomes included the effect of high-risk pathological features of the primary lesion on the proportion of SN metastases. Summary measures were estimated by Mantel-Haenszel method using random effects meta-analyses. RESULTS Sixty studies (10,928 patients) met the criteria for inclusion. Pooled SN positivity was 4.5 % [95 % confidence interval (CI) 3.8-5.2 %]. Predictors of a positive SN were: thickness ≥0.75 mm [adjusted odds ratio (AOR) 1.90 (95 % CI 1.08-3.34); with a likelihood of SN metastases of 8.8 % (95 % CI 6.4-11.2 %)]; Clark level IV/V [AOR 2.24 (95 % CI 1.23-4.08); with a likelihood of 7.3 % (95 % CI 6.2-8.4 %)]; ≥1 mitoses/mm2 [AOR 6.64 (95 % CI 2.77-15.88); pooled likelihood 8.8 % (95 % CI 6.2-11.4 %)]; and the presence of microsatellites [unadjusted OR 6.94 (95 % CI 2.13-22.60); likelihood 26.6 % (95 % CI 4.3-48.9 %)]. CONCLUSIONS The pooled proportion of SN metastases in thin melanoma is 4.5 %. Thickness ≥0.75 mm, Clark level IV/V, mitoses, and microsatellites significantly increased the odds of SN positivity and should prompt strong consideration of SN biopsy.
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Affiliation(s)
- Erin Cordeiro
- Division of General Surgery, The Ottawa Hospital, Ottawa, ON, Canada.
| | - Mai-Kim Gervais
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Prakesh S Shah
- Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Nicole J Look Hong
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Frances C Wright
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Abstract
Although now commonplace in contemporary cancer care, the systematic approach to classification of disease-specific cancers into a formalized staging system is a relatively modern concept. Overall, the goals of cancer staging are to characterize the status of cancer at a specific moment in time, risk stratify, facilitate prognostication, and inform clinical decision making. The revisions to the American Joint Committee on Cancer (AJCC) melanoma staging system over time reflect changes in our understanding of the biology of the disease. Since the 1st edition, where tumor thickness was defined anatomically by its relationship to the reticular or papillary dermis (Clark level) as well as tumor thickness (Breslow thickness), there have been significant strides in our use of clinicopathological variables to stratify low- versus high-risk patients. Management of the regional nodal basin has also changed dramatically over time, impacted by techniques such as lymphatic mapping and sentinel lymph node biopsy (SLNB) and changes in pathological evaluation of the regional lymph nodes. Additionally, stratification of distant metastases has evolved as survival outcomes have been shown to vary based upon anatomic site of metastases and serum lactate dehydrogenase levels. The variables in use in the current (7th edition) AJCC staging system are surrogate markers of biology with validated impact of survival outcomes. Going forward, it is likely that these and additional clinicopathological factors will be integrated with molecular and other correlates of melanoma tumor biology to further refine and personalize melanoma staging.
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Vollmer RT. Probabilistic issues with sentinel lymph nodes in malignant melanoma. Am J Clin Pathol 2015; 144:464-72. [PMID: 26276777 DOI: 10.1309/ajcp50dkltiuazte] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES To address issues of probability for sentinel lymph node results in melanoma and provide details about the probabilistic nature of the numbers of sentinel nodes as well as to address how these issues relate to tumor thickness and patient outcomes. METHODS Analysis of the probability of observing sentinel node metastases uses the discrete exponential probability distribution to address the number of observed positive sentinel nodes. In addition, mathematical functions derived from survival analysis are used. Data are then chosen from the literature to illustrate the approach and to derive results. RESULTS Observations about the numbers of positive and negative sentinel nodes closely follow discrete exponential probability distributions, and the relationship between the probability of a positive sentinel node and tumor thickness follows closely a function derived from survival analysis. Sentinel node results relate to tumor thickness as well as to the total number of nodes harvested but fall short of identifying all those who eventually develop metastatic melanoma. CONCLUSIONS Probability analyses provide useful insight into the success and failure of the sentinel node biopsy procedure in patients with melanoma.
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Kosary CL, Altekruse SF, Ruhl J, Lee R, Dickie L. Clinical and prognostic factors for melanoma of the skin using SEER registries: collaborative stage data collection system, version 1 and version 2. Cancer 2015; 120 Suppl 23:3807-14. [PMID: 25412392 DOI: 10.1002/cncr.29050] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/30/2014] [Accepted: 07/02/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND The objectives of this article are to assess the completeness of the data collected on site-specific factors (SSFs) as a part of Collaborative Stage (CS) version 2 and the impact of the transition from the American Joint Committee on Cancer's (AJCC) 6th to 7th edition guidelines on stage distribution. METHODS Incidence data for melanomas of the skin from 18 Surveillance, Epidemiology, and End Results (SEER) registries (SEER-18) were analyzed. Percentages of unknown cases for 7 SSFs were examined, along with staging trends from 2004 to 2010 and differences in AJCC 6th and 7th edition stage distributions for 2010 cases. RESULTS Fewer than 10% of cases were coded as unknown for SSFs 1 (measured thickness), 2 (ulceration), and 3 (lymph node metastasis). For the remaining SSFs, 36-81% of cases were coded as unknown. Stage distributions were relatively consistent across time and between the AJCC 6th and 7th editions, with the exception of stage IA and stage INOS (not otherwise specified), for which a shift in cases was observed between the AJCC 6th and 7th edition guidelines fOR 2010 cases. CONCLUSIONS A shift of cases out of stage IA and into stage INOS was observed between the AJCC 6th and 7th edition guidelines for 2010 cases. This was attributed to the high number of cases coded as unknown for SSF7 (primary tumor mitotic count/rate). The percentage of cases coded as unknown varied by SSF. Data completeness presents an issue for SSFs introduced in CS version 2.
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Affiliation(s)
- Carol L Kosary
- National Cancer Institute, Division of Cancer Control and Population Sciences, Rockville, Maryland
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Thareja S, Zager JS, Sadhwani D, Thareja S, Chen R, Marzban S, Jukic DM, Glass LF, Messina J. Analysis of tumor mitotic rate in thin metastatic melanomas compared with thin melanomas without metastasis using both the hematoxylin and eosin and anti-phosphohistone 3 IHC stain. Am J Dermatopathol 2014; 36:64-7. [PMID: 24451214 DOI: 10.1097/dad.0b013e31829433b6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Studies have suggested that elevated tumor mitotic rate (MR) is linked to overall survival in thin melanoma. Recently, promising data regarding anti-phosphohistone 3 (pHH3) immunohistochemistry and its ability to aid in calculation of MR have emerged. The authors retrospectively analyzed original biopsies from 13 thin melanomas with positive sentinel node (SN) status and 16 thin melanomas with negative SN status. Both anti-pHH3 immunohistochemistry and the hematoxylin and eosin (H&E) stain were used to evaluate MR by 2 dermatopathologists blinded to SN status using the "hot spot" method. Intraclass coefficient values were attained to measure interobserver concordance and reliability of the pHH3 stain. By generating a receiver operating characteristic curve and analyzing the overall area under the curve, pHH3 was found to have good interobserver reliability. The relationship between MR and SN involvement was also evaluated, but this correlation was not statistically significant.
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Affiliation(s)
- Sumeet Thareja
- *Department of Dermatology, University of South Florida, Tampa, FL; †Department of Cutaneous Oncology, Sarcoma Program, Moffitt Cancer Center; ‡University of Central Florida College of Medicine, Tampa, FL; §Emory University College of Medicine; ¶Biostatistics Core, Clinical and Translational Science Institute, University of South Florida College of Medicine, Tampa, FL; ‖University of South Florida College of Medicine, Tampa, FL; **Department of Pathology and Cell Biology, University of South Florida, Tampa, FL; ††Department of Dermatology, James A. Haley VAMC; ‡‡Department of Dermatology, Moffitt Cancer Center; §§Department of Dermatology, University of South Florida, Tampa, FL; and ¶¶Department of Pathology, Cell Biology and Dermatology, University of South Florida Morsani College of Medicine, Tampa, FL
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Schmalbach CE, Bradford CR. Is sentinel lymph node biopsy the standard of care for cutaneous head and neck melanoma? Laryngoscope 2014; 125:153-60. [PMID: 24986770 DOI: 10.1002/lary.24807] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 06/03/2014] [Accepted: 06/06/2014] [Indexed: 01/03/2023]
Abstract
OBJECTIVES/HYPOTHESIS Sentinel lymph node biopsy (SLNB) is considered one of the most important melanoma advancements to date. Since its inception in 1992, a plethora of data and associated controversies has emerged leading to the question: Is SLNB considered the standard of care for head and neck (HN) cutaneous melanoma? STUDY DESIGN English literature (1990-2014) review. METHODS The PubMed database search was conducted using key terms "melanoma" and "sentinel node." This review included both dedicated HN SLNB studies and larger prospective SLNB studies, in which HN patients were included among the cohort. Bibliography cross-referencing was conducted to ensure a comprehensive search. RESULTS SLNB is safe and accurate in the HN region. Review of large prospective SLNB trials identified the pathologic status of the SLN as the most important prognostic factor for recurrence and survival. Early lymphadenectomy following a positive SLNB imparts a survival benefit. CONCLUSIONS Our review of the current literature suggests that SLNB is the standard of care for selected cases of HN cutaneous melanoma. It is now incorporated into the American Joint Committee on Cancer staging system, the National Comprehensive Cancer Network practice guidelines, and numerous national and international consensus statements.
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Affiliation(s)
- Cecelia E Schmalbach
- Division of Otolaryngology-Head and Neck Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
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Maniakas A, Forest VI, Jozaghi Y, Saliba J, Hier MP, Mlynarek A, Tamilia M, Payne RJ. Tumor classification in well-differentiated thyroid carcinoma and sentinel lymph node biopsy outcomes: a direct correlation. Thyroid 2014; 24:671-4. [PMID: 24199963 DOI: 10.1089/thy.2013.0160] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Predicting locoregional metastasis in well-differentiated thyroid carcinoma (WDTC) is a challenge for thyroid cancer surgeons. Sentinel lymph node biopsy (SLNB) has been shown to be an effective predictive tool. To our knowledge, primary tumor (T) classification has yet to be studied with regard to SLNB. We hypothesized that larger primary tumors would correlate with the rate of malignancy in SLNBs. METHODS A retrospective chart review was conducted on patients operated for WDTC at the McGill Thyroid Cancer Center over a 36-month period. Patients who underwent a total thyroidectomy and SLNB for WDTC were included in this study. RESULTS A total of 311 patients were included and separated into two groups (236 negative and 75 positive SLNBs). Among patients with negative SLNBs, 65% had T1 primary tumors, 17% T2, 16% T3, and 2% T4, whereas 18% of patients with positive SLNBs had T1 primary tumors, 5% T2, 45% T3, and 32% T4 (p<0.001). Patients under the age of 45 years had a higher rate of positive SLNs (36% in those <45 years vs. 17% in those ≥ 45 years; p<0.001). CONCLUSIONS Age (<45 years) and higher T category were found to be associated with a higher rate of positive SLNBs.
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Affiliation(s)
- Anastasios Maniakas
- 1 Department of Otolaryngology-Head and Neck Surgery, McGill Thyroid Cancer Center , Montreal, Canada
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Ahmed MM, Moore BA, Schmalbach CE. Utility of head and neck cutaneous squamous cell carcinoma sentinel node biopsy: a systematic review. Otolaryngol Head Neck Surg 2013; 150:180-7. [PMID: 24201060 DOI: 10.1177/0194599813511949] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Sentinel lymph node biopsy (SLNB) is standard of care for melanoma, but its role in cutaneous squamous cell carcinoma (cSCC) has not been established. Study objectives include: (1) analyze the feasibility and reliability SLNB for head and neck (H&N) cSCC and (2) identify risk factors associated with a positive SLN. DATA SOURCES MEDLINE, PubMed, Cochrane, and ASCO databases searches conducted (1946-2013). REVIEW METHODS Using the PRISM model, a comprehensive systematic review of H&N cSCC SLNB studies with associated recurrence rates was conducted. Dual-blinded data extraction identify primary outcomes (successful SLN harvest and false omission rate) and secondary outcomes (risk factors associated with a +SLN). RESULTS Two hundred twenty-one articles were screened; 73 patients from 11 publications met inclusion criteria (3 case series; 8 prospective cohorts). Studies ranged from 1 to 15 patients (median 5). Median age was 74 years. Median follow-up was 21.5 months. Average tumor size was 3.09 cm. At least 1 SLN was identified in 100% of patients (median 2). Ten (13.5%) had a positive SLN; no additional metastatic nodes were identified in 9 patients receiving completion lymphadenectomy. Tumor diameter was not associated with SLN status (P = .09; 95% CI, -.27 to 3.02). Risk factors (tumor depth, perineural invasion, location, differentiation) were not consistently recorded. Three of 63 (4.76%) failed regionally following a negative SLNB. CONCLUSION H&N cSCC SLNB is feasible and reliable for staging, with a false omission rate of 4.7% mirroring melanoma. Prospective studies documenting high risk features are required to further define its role.
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Affiliation(s)
- Mostafa M Ahmed
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA
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Lima Sánchez J, Sánchez Medina M, García Duque O, Fiúza Pérez M, Carreteri Hernández G, Fernández Palácios J. Sentinel lymph node biopsy for cutaneous melanoma: a 6 years study. Indian J Plast Surg 2013; 46:92-7. [PMID: 23960312 PMCID: PMC3745129 DOI: 10.4103/0970-0358.113717] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: The aim of this study was to evaluate the results of sentinel lymph node biopsy (SLNB) in cutaneous melanoma at our institution. Materials and Methods: 128 patients with primary cutaneous melanoma who underwent SLNB between April, 2004, and August, 2010 were studied. Univariate and multivariate analysis was performed to explore the effect of variables on mortality and sentinel node status. Survival analysis was performed using the Kaplan-Meier approach. Results: Positive SLNB were detected in 35 (27.3%) of 128 cases. Mean Breslow depths were 3.7 mm for SLNB positive patients and 1.99 mm for SLNB negative patients. False negative rate was 1%. The recurrence rate was 40% for positive patients and 6.5% for negative patients (odds ratio 9.7 [confidence interval 95 % 3.3-28.1]). 33 patients (29%) had an ulcerated melanoma, 12 (10.5%) in the positive group and 21 (18.5%) in the negative group. The disease recurred in a 48.5% of patients with ulcerated melanoma, but only in a 2.5% of patients with non-ulcerated melanoma. Upon multivariate analysis, only Breslow thickness (P = 0.005) demonstrate statistically significance for SLNB status. Multivariate analysis for clinicopathologic predictors of death demonstrate statistically significance for Breslow thickness (P = 0.020), ulceration (P = 0.030) and sentinel node status (P = 0.020). Conclusions: This study confirms that the status of the sentinel node is a strong independent prognostic factor with a higher risk of death and lower survival. Patients with ulcerated melanoma are more likely to develop recurrence, and also higher risk of death than patients with non-ulcerated melanoma.
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Affiliation(s)
- Jaime Lima Sánchez
- Department of Plastic, Reconstructive and Aesthetic Surgery, Universitary Hospital of Gran Canaria, Dr. Negrín, Las Palmas de Gran Canaria, Spain
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Migliano E, Bellei B, Govoni FA, Paolino G, Catricalà C, Bucher S, Donati P. SLN melanoma micrometastasis predictivity of nodal status: a long term retrospective study. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2013; 32:47. [PMID: 23902987 PMCID: PMC3737095 DOI: 10.1186/1756-9966-32-47] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 07/26/2013] [Indexed: 02/05/2023]
Abstract
Background Completion lymph node dissection (CLND) is the gold standard treatment for patients with a positive sentinel lymph node (SLN) biopsy. Considering the morbidity associated with CLND it is important to identify histological features of the primary tumor and/or of SLN metastasis that could help to spare from CLND a subset of patients who have a very low risk of non-SLN metastasis. The objective of this study is to identify patients with a very low risk to develop non-SLNs recurrences and to limit unnecessary CLND. Methods A retrospective long-term study of 80 melanoma patients with positive SLN, undergone CLND, was assessed to define the risk of additional metastasis in the regional nodal basin, on the basis of intranodal distribution of metastatic cells, using the micro-morphometric analysis (Starz classification). Results This study demonstrates that among the demographic and pathologic features of primary melanoma and of SLN only the Starz classification shows prognostic significance for non-SLN status (p<0.0001). This parameter was also significantly associated with disease-free survival rate (p<0.0013). Conclusion The Starz classification can help to identify, among SLN positive patients, those who can have a real benefit from CLND. From the clinical point of view this easy and reliable method could lead to a significant reduction of unnecessary CLND in association with a substantial decrease in morbidity. The study results indicate that most of S1 subgroup patients might be safely spared from completion lymphatic node dissection. Furthermore, our experience demonstrated that Starz classification of SLN is a safe predictive index for patient stratification and treatment planning.
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Affiliation(s)
- Emilia Migliano
- Department of Plastic and Reconstructive Surgery, San Gallicano Dermatologic Institute, Rome, Italy.
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van den Broek FJ, Sloots PC, de Waard JWD, Roumen RM. Sentinel lymph node biopsy for cutaneous melanoma: results of 10 years' experience in two regional training hospitals in the Netherlands. Int J Clin Oncol 2013; 18:428-34. [PMID: 22402887 DOI: 10.1007/s10147-012-0399-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 02/19/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND OBJECTIVE The Multicenter Selective Lymphadenectomy Trial (MSLT-I) demonstrated that the sentinel node (SN) status in cutaneous melanoma affects prognosis and that completion lymphadenectomy in SN-positive patients may improve survival. Our objective was to evaluate sentinel lymph node biopsy (SLNB) in two regional hospitals in the Netherlands. METHODS Patients with localized melanoma were planned for wide excision and SLNB. Completion lymphadenectomy was recommended for positive SN status. Data were compared with the MSLT-I. RESULTS A median of 2 (1-7) SNs were identified in 305 patients and complications occurred in 11%. Fifty-four patients (18%) demonstrated SN metastases and 45 underwent completion lymphadenectomy (20% additional metastases). Six patients with initially negative SN developed lymph node metastases (sensitivity 90%). Overall disease-free survival was 83% (SN-negative 91% vs. SN-positive 41%; p < 0.001) and melanoma-specific survival was 93% (SN-negative 97% vs. SN-positive 62%; p < 0.001). Multivariate regression analysis revealed the SN status to be the most significant predictor for recurrence and melanoma-related death. CONCLUSION Our results of SLNB are comparable to data from high-volume centers participating in MSLT-I. From a patient perspective, the false-negative SN rate of 10% and complication rate of 11% should be weighed against being informed about prognosis and having a possible therapeutic benefit from completion lymphadenectomy.
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Hinz T, Voth H, Ahmadzadehfar H, Hoeller T, Wenzel J, Bieber T, Schmid-Wendtner MH. Role of high-resolution ultrasound and PET/CT imaging for preoperative characterization of sentinel lymph nodes in cutaneous melanoma. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:30-36. [PMID: 23122637 DOI: 10.1016/j.ultrasmedbio.2012.08.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 06/29/2012] [Accepted: 08/29/2012] [Indexed: 06/01/2023]
Abstract
The purpose of our study was the comparison of high-resolution ultrasound (HRUS) and positron emission tomography combined with computerised tomography (PET/CT) in the preoperative characterization and identification of subclinical nodal metastases focusing on sentinel lymph nodes (SLN) in melanoma patients. Patients with cutaneous melanoma (CM) who received sentinel lymph node biopsy at the Department of Dermatology and Allergy, University of Bonn, between January 2009 and January 2011 had been evaluated with a retrospective computer-aided search concerning preoperative staging procedures. A combination of PET/CT and HRUS had been performed preoperatively in 20 of 123 patients. A total of 59 SLNs had been removed in those 20 patients followed by histopathologic examination. HRUS correctly identified two of 17 positive SLNs whereas PET/CT imaging identified none. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of HRUS were 11.8 % (95 % confidence interval [CI] = 3.3-34.3), 100 % (95 % CI = 91.6-100.0), 100.0 % (95 % CI = 34.2-100.0), and 73.7 % (95 % CI = 61.0-83.3), respectively. On the basis of this limited study cohort, HRUS had a better value than PET/CT in preoperative identification of positive SLNs, suggesting a possible diagnostic superiority of HRUS in general characterization of peripheral nodal disease in CM.
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Affiliation(s)
- Torsten Hinz
- Department of Dermatology and Allergy, University of Bonn, Bonn, Germany
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Nakamura Y, Nakamura Y, Fujisawa Y, Obara S, Furuta J, Kawachi Y, Otsuka F. Multiple Inguinal and Pelvic Lymph Node Metastases of Malignant Melanoma of the Heel Identified by Common Iliac Lymphadenopathy. Lymphat Res Biol 2012; 10:118-21. [DOI: 10.1089/lrb.2012.0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | - Saeko Obara
- Department of Dermatology, University of Tsukuba, Tsukuba, Japan
| | - Junichi Furuta
- Department of Dermatology, University of Tsukuba, Tsukuba, Japan
| | - Yasuhiro Kawachi
- Department of Dermatology, University of Tsukuba, Tsukuba, Japan
| | - Fujio Otsuka
- Department of Dermatology, University of Tsukuba, Tsukuba, Japan
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Kelly J, Redmond H. The role of sentinel lymph node biopsy in patients with thick melanoma. A single centre experience. Surgeon 2012; 10:65-70. [DOI: 10.1016/j.surge.2011.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 01/26/2011] [Accepted: 01/29/2011] [Indexed: 11/29/2022]
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Prognosis of sentinel node staged patients with primary cutaneous melanoma. PLoS One 2012; 7:e29791. [PMID: 22276129 PMCID: PMC3261856 DOI: 10.1371/journal.pone.0029791] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 12/05/2011] [Indexed: 02/05/2023] Open
Abstract
Background This study investigated survival probabilities and prognostic factors in sentinel lymph node biopsy (SLNB) staged patients with cutaneous melanoma (CM) with the aim of defining subgroups of patients who are at higher risk for recurrences and who should be considered for adjuvant clinical trials. Methods Patients with primary CM who underwent SLNB in the Department of Dermatology, University of Tuebingen, Germany, between 1996 and 2009 were included into this study. Survival probabilities and prognostic factors were evaluated by Kaplan-Meier and multivariate Cox proportional hazard models. Results 1909 SLNB staged patients were evaluated. Median follow-up time was 44 months. Median tumor thickness was 1.8 mm, ulceration was present in 31.8% of cases. The 5-year Overall Survival (OS) was 90.3% in SLNB negative patients (IB 96.2%, IIA 87.0%, IIB 78.1%, IIC 72.6%). Patients with micrometastases (stage IIIA/B) had a 5-year OS rate of 70.9% which was clearly less favorable than for stages I–II. Multivariate analysis revealed tumor thickness, ulceration, body site, histopathologic subtype and SLNB status as independent significant prognostic factors. Conclusion Survival rates of patients with primary CM in stages I–II were shown to be much more favorable than previously reported from non sentinel node staged collectives. For future clinical trials, sample size calculations should be adapted using survival probabilities based on sentinel node staging.
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