1
|
Peirano D, Donoso F, Vargas S, Hidalgo L, Agüero R, Uribe P, Mondaca S, Navarrete-Dechent C. Patterns of Recurrence of Cutaneous Melanoma: A Literature Review. Dermatol Pract Concept 2023; 13:dpc.1304a304. [PMID: 37992344 PMCID: PMC10656145 DOI: 10.5826/dpc.1304a304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/24/2023] Open
Abstract
The incidence of melanoma has been dramatically increasing over the last decades. Melanoma is considered to have a high metastatic potential and it can progress via lymphatic vessels or through hematogenous metastasis. Different patterns of recurrence have been described, namely, local, satellite, and in transit metastasis (LCIT), lymphatic metastasis, and systemic metastasis. With a more advanced melanoma stage at diagnosis, there is a higher risk for systemic metastasis in comparison to LCIT; in contrast, early-stage melanoma tends to recur more frequently as LCIT and less commonly as systematic metastasis. The aim of this review was to summarize the patterns of recurrence of cuta-neous melanoma, giving the clinician a practical summary for diagnosis, prognosis, and surveillance. There is a knowledge gap of the common patterns of recurrence that needs to be addressed to better identify patients at high risk of disease recurrence and personalize surveillance strategies as well as patient counseling.
Collapse
Affiliation(s)
- Dominga Peirano
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisca Donoso
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastián Vargas
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Leonel Hidalgo
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rosario Agüero
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Uribe
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastían Mondaca
- Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Medical Oncology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristian Navarrete-Dechent
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
2
|
Fadel MG, Rauf S, Mohamed HS, Yusuf S, Hayes AJ, Power K, Smith MJ. The Use of Indocyanine Green and Near-Infrared Fluorescence Imaging Versus Blue Dye in Sentinel Lymph Node Biopsy in Cutaneous Melanoma: A Retrospective, Cohort Study. Ann Surg Oncol 2023; 30:4333-4340. [PMID: 37061649 DOI: 10.1245/s10434-023-13405-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/06/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND The use of indocyanine green (ICG) and near-infrared fluorescence imaging is a promising option for sentinel lymph node (SLN) mapping in cutaneous melanoma. The study objective was to compare the performance of ICG and blue dye at detecting SLNs with radioisotope nanocolloid (technetium-99). METHODS Between April 2018 and June 2022, 293 consecutive patients with cutaneous melanoma (Breslow thickness ≥ 0.8 mm) underwent wide local excision and SLN biopsy. Patients were divided into group A (ICG; n = 122) and group B (blue dye; n = 163). All patients underwent SPECT/CT imaging preoperatively. SLN detection parameters and complications were compared between the groups. RESULTS A total of 285 patients had complete data and were included in the analysis. The median age was 62.0 (range 10-91) years, and 139 (48.8%) were female patients. The mean Breslow thickness was 2.6 mm, 89 (31.2%) patients had ulceration, and 179 (62.8%) patients had mitosis ≥ 1 mm2. The mean number of SLNs detected per patient in group A was 1.58 and group B was 1.48. In groups A and B, the SLN detection rate was 96.7% versus 89.6% (p = 0.022) and the pathological SLN detection rate was 92.3% versus 97.1% (p = 0.481), respectively. CONCLUSIONS ICG had a higher SLN detection rate and equal pathological SLN detection rate to blue dye. ICG may not be inferior to blue dye and is a useful adjunct to radioisotope in SLN biopsy in cutaneous melanoma.
Collapse
Affiliation(s)
- Michael G Fadel
- The Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital and Institute Cancer of Research, London, UK
| | - Sidra Rauf
- The Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital and Institute Cancer of Research, London, UK
| | - Hesham S Mohamed
- The Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital and Institute Cancer of Research, London, UK
| | - Siraj Yusuf
- The Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital and Institute Cancer of Research, London, UK
| | - Andrew J Hayes
- The Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital and Institute Cancer of Research, London, UK
| | - Kieran Power
- The Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital and Institute Cancer of Research, London, UK
| | - Myles J Smith
- The Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital and Institute Cancer of Research, London, UK.
| |
Collapse
|
3
|
Indocyanine Green Fluorescence Imaging with Lymphoscintigraphy Improves the Accuracy of Sentinel Lymph Node Biopsy in Melanoma. Plast Reconstr Surg 2021; 148:83e-93e. [PMID: 34181617 DOI: 10.1097/prs.0000000000008096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite advances in melanoma management, there remains room for improvement in the accuracy of sentinel lymph node biopsy. The authors analyzed a prospective cohort of patients with primary cutaneous melanoma who underwent sentinel lymph node biopsy with lymphoscintigraphy and indocyanine green fluorescence to evaluate the quality and accuracy of this technique. METHODS Consecutive primary cutaneous melanoma patients who underwent sentinel lymph node biopsy with radioisotope lymphoscintigraphy and indocyanine green fluorescence from 2012 to 2018 were prospectively enrolled. Analysis was performed of melanoma characteristics, means of identifying sentinel lymph nodes, sentinel lymph node status, and recurrence. RESULTS Five hundred ninety-four melanomas and 1827 nodes were analyzed; 1556 nodes (85.2 percent) were identified by radioactivity/fluorescence, 255 (14 percent) by radioactivity only, and 16 (0.9 percent) with indocyanine green only. There were 163 positive sentinel nodes. One hundred forty-seven (90.2 percent) were identified by radioactivity/fluorescence, 13 (8 percent) by radioactivity only, and three (0.6 percent) with fluorescence only. Of the 128 patients with a positive biopsy, eight patients' (6.3 percent) nodes were identified by radioactivity only and four (3.4 percent) with fluorescence only. There were 128 patients with a positive biopsy, 454 with a negative biopsy, and 12 patients who had a negative biopsy with subsequent nodal recurrence. Mean follow-up was 2.8 years. CONCLUSIONS In the study of the largest cohort of patients with primary cutaneous melanoma who underwent a sentinel lymph node biopsy with radioisotope lymphoscintigraphy and indocyanine green-based technology, the quality and accuracy of this technique are demonstrated. This has important implications for melanoma patients, as the adoption of this approach with subsequent accurate staging, adjuvant workup, and treatment may improve survival outcomes. . CLINICAL QUESTION/LEVEL OF EVIDENCE Diagnostic, II.
Collapse
|
4
|
Kim D, Chu S, Khan AU, Compres EV, Zhang H, Gerami P, Wayne JD. Risk factors and patterns of recurrence after sentinel lymph node biopsy for thin melanoma. Arch Dermatol Res 2021; 314:285-292. [PMID: 33884478 DOI: 10.1007/s00403-021-02229-8] [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: 10/14/2020] [Revised: 03/07/2021] [Accepted: 04/08/2021] [Indexed: 11/30/2022]
Abstract
While having a thin melanoma (defined as AJCC 8 T1 stage tumor ≤ 1.0 mm) with negative sentinel lymph node biopsy (SLNB) provides an excellent prognosis, some patients still develop recurrence and die. To determine risk factors for any recurrence (local/in-transit, nodal, distant) in thin melanoma patients with negative SLNB and assess survival outcomes. Retrospective review of thin melanomas with negative SLNB from 1999 to 2018 was performed. Two hundred and nine patients were identified. Clinicopathologic characteristics of the primary melanoma were collected. Patterns of recurrence for local/in-transit, nodal or distant recurrence and survival outcomes were analyzed. Eighteen patients (8.6%) developed recurrence: 3 (1.9%) local/in-transit, 4 (2.9%) regional/nodal, and 11 (5.3%) distant recurrence during a median follow-up time of 62 months. A multivariate Cox regression model showed that head and neck site (HR 3.52), ulceration (HR 10.8), and mitotic rate (HR 1.39) were significant risk factors for recurrence. Median time to first recurrence was 49 months. Patients with recurrence had a significantly worse 5 year overall survival than those without recurrence (82.2 vs 99.2%). A retrospective single center study and limited sample size. Did not factor in possible false negative SLNBs when calculating hazard ratios. For thin melanoma patients with negative SLNB, heightened surveillance is warranted for those with ulceration, primary tumor location on the head or neck, and elevated mitotic rate.
Collapse
Affiliation(s)
- Daniel Kim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Stanley Chu
- Division of Surgical Oncology, Department of Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Arkes 650, Chicago, IL, 60611, USA
| | - Ayesha U Khan
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Elsy V Compres
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Hui Zhang
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jeffrey D Wayne
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. .,Division of Surgical Oncology, Department of Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Arkes 650, Chicago, IL, 60611, USA. .,Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| |
Collapse
|
5
|
Giuntini G, Monaci S, Cau Y, Mori M, Naldini A, Carraro F. Inhibition of Melanoma Cell Migration and Invasion Targeting the Hypoxic Tumor Associated CAXII. Cancers (Basel) 2020; 12:E3018. [PMID: 33080820 PMCID: PMC7602957 DOI: 10.3390/cancers12103018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/09/2020] [Accepted: 10/14/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Intratumoral hypoxia contributes to cancer progression and poor prognosis. Carbonic anhydrases IX (CAIX) and XII (CAXII) play pivotal roles in tumor cell adaptation and survival, as aberrant Hedgehog (Hh) pathway does. In malignant melanoma both features have been investigated for years, but they have not been correlated before and/or identified as a potential pharmacological target. Here, for the first time, we demonstrated that malignant melanoma cell motility was impaired by targeting CAXII via either CAs inhibitors or through the inhibition of the Hh pathway. METHODS We tested cell motility in three melanoma cell lines (WM-35, SK-MEL28, and A375), with different invasiveness capabilities. To this end we performed a scratch assay in the presence of the smoothened (SMO) antagonist cyclopamine (cyclo) or CAs inhibitors under normoxia or hypoxia. Then, we analyzed the invasiveness potential in the cell lines which were more affected by cyclo and CAs inhibitors (SK-MEL28 and A375). Western blot was employed to assess the expression of the hypoxia inducible factor 1α, CAXII, and FAK phosphorylation. Immunofluorescence staining was performed to verify the blockade of CAXII expression. RESULTS Hh inhibition reduced melanoma cell migration and CAXII expression under both normoxic and hypoxic conditions. Interestingly, basal CAXII expression was higher in the two more aggressive melanoma cell lines. Finally, a direct CAXII blockade impaired melanoma cell migration and invasion under hypoxia. This was associated with a decrease of FAK phosphorylation and metalloprotease activities. CONCLUSIONS CAXII may be used as a target for melanoma treatment not only through its direct inhibition, but also through Hh blockade.
Collapse
Affiliation(s)
- Gaia Giuntini
- Department of Molecular and Developmental Medicine, Cellular and Molecular Physiology Unit, University of Siena, 53100 Siena, Italy; (G.G.); (S.M.); (A.N.)
| | - Sara Monaci
- Department of Molecular and Developmental Medicine, Cellular and Molecular Physiology Unit, University of Siena, 53100 Siena, Italy; (G.G.); (S.M.); (A.N.)
| | - Ylenia Cau
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, 53100 Siena, Italy; (Y.C.); (M.M.)
| | - Mattia Mori
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, 53100 Siena, Italy; (Y.C.); (M.M.)
| | - Antonella Naldini
- Department of Molecular and Developmental Medicine, Cellular and Molecular Physiology Unit, University of Siena, 53100 Siena, Italy; (G.G.); (S.M.); (A.N.)
| | - Fabio Carraro
- Department of Medical Biotechnologies, Cellular and Molecular Physiology Unit, University of Siena, 53100 Siena, Italy
| |
Collapse
|
6
|
Hanks JE, Yalamanchi P, Kovatch KJ, Ali SA, Smith JD, Durham AB, Bradford CR, Malloy KM, McLean SA. Cranial nerve outcomes in regionally recurrent head & neck melanoma after sentinel lymph node biopsy. Laryngoscope 2020; 130:1707-1714. [PMID: 31441955 DOI: 10.1002/lary.28243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/28/2019] [Accepted: 07/31/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Characterize long-term cranial nerve (CN) outcomes following sentinel lymph node biopsy (SLNB) based management for head and neck cutaneous melanoma (HNCM). METHODS Longitudinal review of HNCM patients undergoing SLNB from 1997-2007. RESULTS Three hundred fifty-six patients were identified, with mean age 53.5 ± 19.0 years, mean Breslow depth 2.52 ± 1.87 mm, and 4.9 years median follow-up. One hundred five (29.4%) patients had SLNB mapping to the parotid basin. Eighteen patients had positive parotid SLNs and underwent immediate parotidectomy / immediate completion lymph node dissection (iCLND), with six possessing positive parotid non-sentinel lymph nodes (NSLNs). Fifty-two of 356 (14.6%) patients developed delayed regional recurrences, including 20 total intraparotid recurrences: five following false negative (FN) parotid SLNB, three following prior immediate superficial parotidectomy, two following iCLND without parotidectomy, and the remaining 12 parotid recurrences had negative extraparotid SLNBs. Parotid recurrences were multiple (4.9 mean recurrent nodes) and advanced (n = 4 extracapsular extension), and all required salvage dissection including parotidectomy. Immediate parotidectomy/iCLND led to no permanent CN injuries. Delayed regional HNCM macrometastasis precipitated 16 total permanent CN injuries in 13 patients: 10 CN VII, five CN XI, and one CN XII deficits. Fifty percent (n = 10) of parotid recurrences caused ≥1 permanent CN deficits. CONCLUSIONS Regional HNCM macrometastases and salvage dissection confer marked CN injury risk, whereas early surgical intervention via SLNB ± iCLND ± immediate parotidectomy yielded no CN injuries. Further, superficial parotidectomy performed in parotid-mapping HNCM does not obviate delayed intraparotid recurrences, which increase risk of CN VII injury. Despite lack of a published disease-specific survival advantage in melanoma, early disease control in cervical and parotid basins is paramount to minimize CN complications. LEVEL OF EVIDENCE 4 (retrospective case series) Laryngoscope, 130:1707-1714, 2020.
Collapse
Affiliation(s)
- John E Hanks
- Department of Otolaryngology-Head & Neck Surgery, University of California-Davis Medical center, Ann Arbor, Michigan, U.S.A
| | - Pratyusha Yalamanchi
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Kevin J Kovatch
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - S Ahmed Ali
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Joshua D Smith
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Alison B Durham
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Carol R Bradford
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, U.S.A
- University of Michigan Medical School, Ann Arbor, Michigan, U.S.A
| | - Kelly M Malloy
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Scott A McLean
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, U.S.A
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Adequacy of sentinel lymph node biopsy in malignant melanoma of the trunk and extremities: Clinical observations regarding prognosis. Arch Plast Surg 2020; 47:42-48. [PMID: 31964122 PMCID: PMC6976750 DOI: 10.5999/aps.2019.00934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 10/18/2019] [Indexed: 12/03/2022] Open
Abstract
Background Methods for identifying local lymph node metastasis in malignant melanoma include sentinel lymph node biopsy (SLNB) and lymph node dissection (LND). In particular, SLNB has been widely used in recent years. This study aimed to retrospectively confirm the adequacy of the current indication criteria for SLNB by applying those criteria to a mixed group of patients who previously received SLNB and LND. Methods This study included 77 patients with malignant melanoma of the extremities and trunk who were monitored for >24 months. The patients were classified according to whether the current indication criteria for SLNB were applicable. The sentinel lymph nodes were evaluated for each group. Patients for whom the indication criteria for SLNB and LND were applicable were analyzed according to whether SLNB or LND was performed. Finally, the outpatient records of these patients were reviewed to evaluate recurrence, metastasis, and prognosis. Results Of the 77 patients, SLNB was indicated according to the current criteria in 60 cases. Among the 60 patients for whom SLNB was indicated, 35 survived the follow-up period disease-free, 21 died during the follow-up period, and four experienced metastasis. The 17 patients for whom SLNB was not indicated had no recurrence or metastasis. Conclusions Patients for whom SLNB was not indicated had no recurrence or metastasis. In cases where SLNB is indicated, the possibility of metastasis and recurrence may be high even if SLNB is negative or LND is performed, so more aggressive treatment and careful follow-up are crucial.
Collapse
|
9
|
Knackstedt R, Couto RA, Ko J, Cakmakoglu C, Wu D, Gastman B. Indocyanine Green Fluorescence Imaging with Lymphoscintigraphy for Sentinel Node Biopsy in Melanoma: Increasing the Sentinel Lymph Node-Positive Rate. Ann Surg Oncol 2019; 26:3550-3560. [PMID: 31313036 DOI: 10.1245/s10434-019-07617-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Indexed: 12/17/2023]
Abstract
INTRODUCTION The goal of this study was to analyze patients who underwent a sentinel lymph node biopsy (SLNB) in melanoma with the combination of radioisotope lymphoscintigraphy and indocyanine green (ICG) fluorescence imaging to compare our true positive (TP) rate, a means to perform immediate analysis of the SLNB, with that of the literature. METHODS Consecutive cutaneous melanoma patients who underwent SLNB with lymphoscintigraphy and ICG-based fluorescence imaging by the senior author (BG) from 2012 to 2018 were prospectively enrolled. The average expected SLN-positive rate per T stage was calculated based on three studies and compared with our SLN-positive rate. RESULTS Overall, 574 consecutive patients were analyzed. Average Breslow thickness was 1.9 mm. A total of 1754 sentinel nodes were sampled; 1497 were identified by gamma probe signaling and ICG, 241 were identified by gamma probe signaling only, and 16 were identified by ICG only. There were 123 (21.4%) patients with at least one positive SLN; 113 (91.9%) had at least one positive node identified with both gamma probe signaling and ICG, 8 (6.5%) had positive node(s) identified with gamma probe signaling only, and 2 (1.6%) had positive node(s) identified with ICG only. There was an overall 21.4% SLN-positive rate, with 8% T1, 18.5% T2, 41.1% T3, and 52.4% T4, which is higher than the predicted rates for each stage. CONCLUSIONS With the largest cohort of patients reported who underwent a melanoma SLNB with lymphoscintigraphy and ICG, we demonstrated that this technique results in higher SLN-positive rates than predicted. Patients are being followed but, given the TP data, knowledge of our results may foster the use of this modality to improve staging and treatment options.
Collapse
Affiliation(s)
- Rebecca Knackstedt
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Rafael A Couto
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jennifer Ko
- Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Cagri Cakmakoglu
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Daisy Wu
- University of Toledo Medical School, Toledo, OH, USA
| | - Brian Gastman
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
| |
Collapse
|
10
|
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.
Collapse
Affiliation(s)
- Roberto Cecchi
- Cutaneous Surgery Service, Pistoia Hospital, Pistoia, Italy.
| | | | | | | |
Collapse
|
11
|
Ipenburg NA, Nieweg OE, Ahmed T, van Doorn R, Scolyer RA, Long GV, Thompson JF, Lo S. External validation of a prognostic model to predict survival of patients with sentinel node-negative melanoma. Br J Surg 2019; 106:1319-1326. [PMID: 31310333 PMCID: PMC6790583 DOI: 10.1002/bjs.11262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 05/13/2019] [Indexed: 12/23/2022]
Abstract
Background Identifying patients with sentinel node‐negative melanoma at high risk of recurrence or death is important. The European Organisation for Research and Treatment of Cancer (EORTC) recently developed a prognostic model including Breslow thickness, ulceration and site of the primary tumour. The aims of the present study were to validate this prognostic model externally and to assess whether it could be improved by adding other prognostic factors. Methods Patients with sentinel node‐negative cutaneous melanoma were included in this retrospective single‐institution study. The β values of the EORTC prognostic model were used to predict recurrence‐free survival and melanoma‐specific survival. The predictive performance was assessed by discrimination (c‐index) and calibration. Seeking to improve the performance of the model, additional variables were added to a Cox proportional hazards model. Results Some 4235 patients with sentinel node‐negative cutaneous melanoma were included. The median follow‐up time was 50 (i.q.r. 18·5–81·5) months. Recurrences and deaths from melanoma numbered 793 (18·7 per cent) and 456 (10·8 per cent) respectively. Validation of the EORTC model showed good calibration for both outcomes, and a c‐index of 0·69. The c‐index was only marginally improved to 0·71 when other significant prognostic factors (sex, age, tumour type, mitotic rate) were added. Conclusion This study validated the EORTC prognostic model for recurrence‐free and melanoma‐specific survival of patients with negative sentinel nodes. The addition of other prognostic factors only improved the model marginally. The validated EORTC model could be used for personalizing follow‐up and selecting high‐risk patients for trials of adjuvant systemic therapy.
Collapse
Affiliation(s)
- N A Ipenburg
- Melanoma Institute Australia, University of Sydney, Sydney, New South Wales, Australia.,Department of Dermatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - O E Nieweg
- Melanoma Institute Australia, University of Sydney, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - T Ahmed
- Melanoma Institute Australia, University of Sydney, Sydney, New South Wales, Australia
| | - R van Doorn
- Department of Dermatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - R A Scolyer
- Melanoma Institute Australia, University of Sydney, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - G V Long
- Melanoma Institute Australia, University of Sydney, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - J F Thompson
- Melanoma Institute Australia, University of Sydney, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - S Lo
- Melanoma Institute Australia, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
12
|
Thomas DC, Han G, Leong SP, Kashani-Sabet M, Vetto J, Pockaj B, White RL, Faries MB, Schneebaum S, Mozzillo N, Charney KJ, Sondak VK, Messina JL, Zager JS, Han D. Recurrence of Melanoma After a Negative Sentinel Node Biopsy: Predictors and Impact of Recurrence Site on Survival. Ann Surg Oncol 2019; 26:2254-2262. [DOI: 10.1245/s10434-019-07369-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Indexed: 01/03/2023]
|
13
|
Sirvan SS, Demir IA, Irmak F, Kafi M, Budak K, Karsidag S. Does Wide Excisional Biopsy in Skin Cancer Prevent Finding The Real Sentinel Lymph Node? J INVEST SURG 2019; 33:741-747. [DOI: 10.1080/08941939.2018.1559898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Selami S Sirvan
- Plastic, Reconstructive and Aesthetic Surgery Department, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Isil Akgun Demir
- Plastic, Reconstructive and Aesthetic Surgery Department, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Fatih Irmak
- Plastic, Reconstructive and Aesthetic Surgery Department, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Mesut Kafi
- Nuclear Medicine Department, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Kenan Budak
- Nuclear Medicine Department, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Semra Karsidag
- Plastic, Reconstructive and Aesthetic Surgery Department, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
14
|
Indocyanine green fluorescence imaging with lymphoscintigraphy for sentinel node biopsy in head and neck melanoma. J Surg Res 2018; 228:77-83. [DOI: 10.1016/j.jss.2018.02.064] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/11/2017] [Accepted: 02/27/2018] [Indexed: 02/05/2023]
|
15
|
Adler NR, Wolfe R, McArthur GA, Kelly JW, Haydon A, McLean CA, Mar VJ. Tumour mutation status and melanoma recurrence following a negative sentinel lymph node biopsy. Br J Cancer 2018; 118:1289-1295. [PMID: 29755118 PMCID: PMC5959932 DOI: 10.1038/s41416-018-0088-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/12/2018] [Accepted: 03/27/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND A proportion of patients develop recurrence following a tumour-negative sentinel lymph node biopsy (SLNB). This study aimed to explore whether melanoma patients with BRAF or NRAS mutant tumours have an increased risk of developing disease recurrence following a negative SLNB compared to patients with wild-type tumours. METHODS Prospective cohort study of melanoma patients at three tertiary referral centres in Melbourne, who underwent SLNB. Clinical, pathological and molecular characteristics and recurrence data were prospectively recorded. Multivariate Cox proportional hazards regression models estimated the adjusted hazard ratio (aHR) and corresponding 95% confidence interval (CI) for the association between mutation status and development of recurrence following a negative-SLNB. RESULTS Overall, 344/477 (72.1%) patients had a negative SLNB. Of these, 54 (15.7%) developed subsequent recurrence. The risk of disease recurrence following a negative SLNB was increased for patients with either a BRAF or NRAS mutant tumour compared to wild-type tumours (aHR 1.92, 95% CI: 1.02-3.60, p = 0.04). CONCLUSION Melanoma patients with BRAF or NRAS mutant tumours had an increased risk compared to patients with BRAF/NRAS wild-type tumours of developing disease recurrence following a tumour-negative SLNB. The findings also confirm the importance of continued surveillance to monitor for disease recurrence among SLNB-negative patients.
Collapse
Affiliation(s)
- Nikki R Adler
- Victorian Melanoma Service, Alfred Hospital, Melbourne, VIC, 3004, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Grant A McArthur
- Divisions of Research and Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, 3000, Australia
| | - John W Kelly
- Victorian Melanoma Service, Alfred Hospital, Melbourne, VIC, 3004, Australia
| | - Andrew Haydon
- Victorian Melanoma Service, Alfred Hospital, Melbourne, VIC, 3004, Australia
- Department of Medical Oncology, Alfred Hospital, Melbourne, VIC, 3004, Australia
| | - Catriona A McLean
- Victorian Melanoma Service, Alfred Hospital, Melbourne, VIC, 3004, Australia
- Department of Anatomical Pathology, Alfred Hospital, Melbourne, VIC, 3004, Australia
| | - Victoria J Mar
- Victorian Melanoma Service, Alfred Hospital, Melbourne, VIC, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
- Skin and Cancer Foundation, Carlton, VIC, 3053, Australia
| |
Collapse
|
16
|
Determining the False-Negative Rate Using Fluorescence Image–Assisted Sentinel Lymph Node Biopsy in Cutaneous Melanoma. Ann Plast Surg 2018; 80:54-58. [DOI: 10.1097/sap.0000000000001211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
17
|
Castaneda CA, Torres-Cabala C, Castillo M, Villegas V, Casavilca S, Cano L, Sanchez J, Dunstan J, Calderon G, De La Cruz M, Cotrina JM, Gomez HL, Galvez R, Abugattas J. Tumor infiltrating lymphocytes in acral lentiginous melanoma: a study of a large cohort of cases from Latin America. Clin Transl Oncol 2017; 19:1478-1488. [PMID: 28577153 DOI: 10.1007/s12094-017-1685-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Acral lentiginous melanoma (ALM) is a poor prognosis subtype and is the most prevalent in non-Caucasian populations. The presence of tumor infiltrating lymphocytes (TILs) has been associated with poor prognosis in melanoma. A large cohort of ALM cases was studied to determine status of TIL and its association with outcome. METHODS All patients with cutaneous melanoma presenting from 2005 to 2012 at Instituto Nacional de Enfermedades Neoplasicas in Peru were retrospectively identified. Clinicopathological information was obtained from the medical charts. A prospective evaluation of TIL was performed. Analysis of association between ALM and clinicopathological features including TIL as well as survival analysis compared the outcome of ALM to whole group and extremity NALM was performed. RESULTS 537 ALM from a total of 824 cutaneous melanoma cases were studied. Older age (p = 0.022), higher Breslow (p = 0.008) and ulceration (p < 0.001) were found to be more frequent in ALM. Acral had worse overall survival (OS) compared with the whole group (p = 0.04). Clinical stage (CS) I-II patients had a median OS of 5.3 (95% CI 4.3-6.2) for ALM and 9.2 (95% CI 5.0-7.0) for extremity NALM (p = 0.016). Grade 0 (absence of TIL), I, II and III were found in 7.5, 34.5, 32.1, and 25.9%, respectively. Lower TIL grade was associated with larger tumor size (p = 0.003), higher Breslow (p = 0.001), higher Clark level (p = 0.007), higher CS (p = 0.002), extremity location (p = 0.048), histological subtype ALM (p = 0.024) and better OS (p = 0.001). CONCLUSIONS ALM is highly prevalent in Peru and carries poor outcome. Lower TIL levels were associated with poor outcome and ALM.
Collapse
Affiliation(s)
- C A Castaneda
- Medical Oncology Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru.
- Research Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru.
| | - C Torres-Cabala
- Departments of Pathology and Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - M Castillo
- Research Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - V Villegas
- Research Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - S Casavilca
- Pathology Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - L Cano
- Research Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - J Sanchez
- Research Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - J Dunstan
- Breast Cancer Surgery Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - G Calderon
- Breast Cancer Surgery Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - M De La Cruz
- Breast Cancer Surgery Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - J M Cotrina
- Breast Cancer Surgery Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - H L Gomez
- Medical Oncology Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - R Galvez
- Research Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - J Abugattas
- Breast Cancer Surgery Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| |
Collapse
|
18
|
Zhang M, Zhang N. Clinical and prognostic factors in 98 patients with malignant melanoma in China. J Int Med Res 2017; 45:1369-1377. [PMID: 28587543 PMCID: PMC5625536 DOI: 10.1177/0300060517708922] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 04/18/2017] [Indexed: 12/11/2022] Open
Abstract
Objective To investigate clinical and prognostic factors in patients with malignant melanoma (MM) in China. Methods A total of 98 MM patients were enrolled in the study. Enumeration data were analyzed using Fisher's exact probability tests or χ2 tests. Survival rates were calculated using log-rank tests. A Cox multivariate regression analysis was performed to determine independent prognostic factors. Results The male: female incidence ratio was 1.88:1. The highest incidence rate was seen in the 45-65 year age group. Primary lesion ulceration was seen in 60.2% of patients. The 1-year, 3-year and 5-year survival rates were 85.7%, 34.7% and 13.3%, respectively. In univariate analyses, the 5-year survival rate in patients was significantly associated with ulceration (P < 0.01), clinical stage (P < 0.01) and surgical excision of the tumor (P < 0.01). Cox multivariate regression analysis confirmed that ulceration and clinical stage were independent prognostic factors. Conclusions Some clinical characteristics of MM patients in China are significantly different from those of patients in Western countries. Ulceration and clinical stage are independent risk factors for poor survival in MM patients.
Collapse
Affiliation(s)
- Min Zhang
- Department of Dermatology, Jinan Central Hospital Affiliated to Shandong University, Jinan, China
| | - Nan Zhang
- Department of Oncology, Jinan Central Hospital Affiliated to Shandong University, Jinan, China
| |
Collapse
|
19
|
Ward CE, MacIsaac JL, Heughan CE, Weatherhead L. Metastatic Melanoma in Sentinel Node-Negative Patients: The Ottawa Experience. J Cutan Med Surg 2017; 22:14-21. [PMID: 28689448 DOI: 10.1177/1203475417720201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Lymph node involvement is a major independent prognostic factor for survival in patients with malignant melanoma. Sentinel lymph node biopsy (SLNB) detection of microscopic nodal melanoma has been shown to improve both 5-year survival and 5-year disease-free survival. OBJECTIVE To determine the rate of metastatic melanoma in SLNB-negative patients at long-term follow-up. METHODS Study subjects include all 152 patients who had a negative SLNB and were followed at the Ottawa Regional Cancer Centre (ORCC) between 1999 and 2004. Patients with a follow-up period less than 6 months, more than 1 primary melanoma, and metastatic melanoma at diagnosis were excluded. Age at diagnosis, sex, Breslow thickness, ulceration, mitoses, regression, Clark level, anatomical location, development of metastatic melanoma, time to detection of metastatic disease, and time to death from melanoma were studied. RESULTS In this retrospective study at the ORCC, 40 of 140 (28.6%) patients with a single primary melanoma developed metastatic melanoma following negative SLNB at a mean follow-up of 63 months. CONCLUSION The rate of metastatic melanoma following negative SLNB at long-term follow-up at the ORCC is higher than the upper limit of rates reported in the literature (6%-24%). The reason for this is multifactorial, and the long follow-up period of 5 years allowed for detection of metastatic disease at a mean of 3.9 years. Long-term prognosis may be guarded in node-negative patients with a primary cutaneous melanoma, and surveillance by a multidisciplinary team is crucial.
Collapse
Affiliation(s)
- Chloe E Ward
- 1 Division of Dermatology, University of Ottawa, Ottawa, ON, Canada
| | | | - Caroline E Heughan
- 2 Division of Clinical Dermatology and Cutaneous Science, Dalhousie University, Halifax, NS, Canada
| | | |
Collapse
|
20
|
Sinnamon AJ, Neuwirth MG, Bartlett EK, Zaheer S, Etherington MS, Xu X, Elder DE, Czerniecki BJ, Fraker DL, Karakousis GC. Predictors of false negative sentinel lymph node biopsy in trunk and extremity melanoma. J Surg Oncol 2017. [PMID: 28650537 DOI: 10.1002/jso.24743] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Nodal recurrence following negative sentinel lymph node biopsy (SLNB) for melanoma is known as false-negative (FN) SLNB. Risk factors for FN SLNB among patients with trunk and extremity melanoma have not been well-defined. METHODS After retrospective review, SLNB procedures were classified FN, true positive (TP; positive SLNB), or true negative (TN; negative SLNB without recurrence). Factors associated with high false negative rate (FNR) and low negative predictive value (NPV) were identified by comparing FNs to TPs and TNs, respectively. Survival was evaluated using Kaplan-Meier methods. RESULTS Of 1728 patients, 234 were TP and 37 were FN for overall FNR of 14% and NPV of 97.5%. Age ≥65 years was independently associated with high FNR (FNR 20% in this group). Breslow thickness >1 mm and ulceration were independently associated with low NPV. Among patients with ulcerated tumors >4 mm, NPV was 88%. Median time to recurrence for FNs was 13 months. Among patients with primary melanomas ≤2 mm in depth, overall and distant disease-free survival were significantly shorter with FN SLNB than TP SLNB. CONCLUSIONS Older age is associated with increased FNR; patients with thick, ulcerated lesions should be considered for increased nodal surveillance after negative SLNB given low NPV in this group.
Collapse
Affiliation(s)
- Andrew J Sinnamon
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Madalyn G Neuwirth
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Edmund K Bartlett
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Salman Zaheer
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark S Etherington
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Xiaowei Xu
- Department of Pathology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David E Elder
- Department of Pathology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian J Czerniecki
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Douglas L Fraker
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | | |
Collapse
|
21
|
Sehgal R, Cheung CX, Alradadi R, Healy DA, Landers R, O'Donoghue GT. University Hospital Waterford: 5-year experience of cutaneous melanoma. Ir J Med Sci 2016; 186:309-314. [PMID: 27873142 DOI: 10.1007/s11845-016-1531-6] [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: 08/11/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The incidence of cutaneous melanoma (CM) continues to rise in Ireland. Despite significant advances in melanoma molecular therapy, surgery remains the mainstay of treatment for CM. The University Hospital Waterford (UHW) prospectively maintained CM registry was established in 2010. AIM To summarize 5-year experience (2010-2015) of primary CM presenting to UHW. METHODS Data were retrospectively obtained from a central electronic pathology and radiology repository augmented by HIPE data and theatre logs. Data collected included patient demographics and clinico-pathological characteristics, specimen number, size, anatomical location, melanoma subtype, Breslow thickness, Clark's level, ulceration, and mitosis. RESULTS 592 CMs were managed in UHW during the study period. Overall, females comprised the majority of cases with mean age at presentation 60.78 ± 18.29 years. The most commonly affected anatomical location was the lower limb (26.7%) followed by the back (15.1%), upper limb (15.07%), and face (14.40%). Superficial spreading and lentigo maligna were the most common histological subtype accounting for 19.8 and 20%, respectively. Overall, the mean Breslow depth was 2.4 ± 3.7 mm with corresponding Clark's Level III. Sentinel lymph node positivity was 39/103 (37.89%) most commonly located in the axilla (53.8%) and groin (30.7%). CONCLUSION There has been a steady increase in the number of cutaneous melanoma presentations over the past 5-years to the South East Cancer Centre. Patients are managed best by prompt surgical excision and multidisciplinary management. Our results are in keeping with international standards and work continues in determining overall 5-year survival and recurrence rates.
Collapse
Affiliation(s)
- R Sehgal
- Department of Breast and Endocrine Surgery, University Hospital Waterford, Waterford, Ireland.
| | - C X Cheung
- Department of Breast and Endocrine Surgery, University Hospital Waterford, Waterford, Ireland
| | - R Alradadi
- Department of Breast and Endocrine Surgery, University Hospital Waterford, Waterford, Ireland
| | - D A Healy
- Department of Breast and Endocrine Surgery, University Hospital Waterford, Waterford, Ireland
| | - R Landers
- Department of Breast and Endocrine Surgery, University Hospital Waterford, Waterford, Ireland
| | - G T O'Donoghue
- Department of Breast and Endocrine Surgery, University Hospital Waterford, Waterford, Ireland
| |
Collapse
|
22
|
Predictors and patterns of melanoma recurrence following a negative sentinel lymph node biopsy. Melanoma Res 2016; 26:66-70. [PMID: 26460498 DOI: 10.1097/cmr.0000000000000211] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
To analyse the patient demographics, tumour characteristics and follow-up data of patients with recurrence of melanoma following a negative sentinel lymph node biopsy. A retrospective review of a prospectively maintained melanoma database was conducted. Melanoma patients who had a negative sentinel lymph node were identified and we performed statistical analysis on their respective demographics, tumour histology characteristics and follow-up data. Of 164 patients studied, 40 (24%) had a recurrence of melanoma at a median of 39.5 months following diagnosis (range 1-92 months). Distant metastases were the most common form of disease recurrence (40% of all recurrences). Increasing tumour thickness was an independent predictor of recurrence on multivariate analysis while nodular histology approached significance. Median survival of 6 months was seen following disease recurrence (range 1-126 months). In the setting of a negative sentinel lymph node biopsy, there remains a risk of melanoma recurrence. Distant metastases were the most common form of recurrence. Disease recurrence occurred more frequently in those with thick primary tumours. Recurrences occurred at long intervals from diagnosis indicating the need to consider prolonged patient follow-up.
Collapse
|
23
|
Faut M, Wevers KP, van Ginkel RJ, Diercks GFH, Hoekstra HJ, Kruijff S, Been LB, van Leeuwen BL. Nodular Histologic Subtype and Ulceration are Tumor Factors Associated with High Risk of Recurrence in Sentinel Node-Negative Melanoma Patients. Ann Surg Oncol 2016; 24:142-149. [PMID: 27646020 PMCID: PMC5179586 DOI: 10.1245/s10434-016-5566-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Indexed: 12/16/2022]
Abstract
Background Since its introduction, the sentinel lymph node biopsy (SLNB) has become the standard staging procedure in clinical node-negative melanoma patients. A negative SLNB, however, does not guarantee a recurrence-free survival. Insight into metastatic patterns and risk factors for recurrence in SLNB negative melanoma patients can provide patient tailored guidelines. Methods Data concerning melanoma patients who underwent SLNB between 1996 and 2015 in a single center were prospectively collected. Cox regression analyses were used to determine variables associated with overall recurrence and distant first site of recurrence in SLNB-negative patients. Results In 668 patients, SLNBs were performed between 1996 and 2015. Of these patients, 50.4 % were male and 49.6 % female with a median age of 55.2 (range 5.7–88.8) years. Median Breslow thickness was 2.2 (range 0.3–20) mm. The SLNB was positive in 27.8 % of patients. Recurrence rates were 53.2 % in SLNB-positive and 17.9 % in SLNB-negative patients (p < 0.001). For SLNB-negative patients, the site of first recurrence was distant in 58.5 %. Melanoma located in the head and neck region (hazard ratio 4.88, p = 0.003) and increasing Breslow thickness (hazard ratio 1.15, p = 0.013) were predictive for distant first site of recurrence in SLNB-negative patients. SLNB-negative patients with a nodular melanoma and ulceration had a recurrence rate of 43.1 %; the site of recurrence was distant in 64 % of these patients. Conclusions The recurrence rates of SLNB-negative nodular ulcerative melanoma patients approach those of SLNB-positive patients. Stringent follow-up is recommended in this subset of patients.
Collapse
Affiliation(s)
- Marloes Faut
- Departments of Surgical Oncology and Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Kevin P Wevers
- Departments of Surgical Oncology and Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robert J van Ginkel
- Departments of Surgical Oncology and Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gilles F H Diercks
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Harald J Hoekstra
- Departments of Surgical Oncology and Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Schelto Kruijff
- Departments of Surgical Oncology and Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lukas B Been
- Departments of Surgical Oncology and Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Barbara L van Leeuwen
- Departments of Surgical Oncology and Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| |
Collapse
|
24
|
Chen J, Xu Y, Zhou Y, Wang Y, Zhu H, Shi Y. Prognostic role of sentinel lymph node biopsy for patients with cutaneous melanoma: A retrospective study of surveillance, epidemiology, and end-result population-based data. Oncotarget 2016; 7:45671-45677. [PMID: 27344178 PMCID: PMC5216751 DOI: 10.18632/oncotarget.10140] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 06/03/2016] [Indexed: 02/05/2023] Open
Abstract
Sentinel lymph node biopsy (SLNB) is a sensitive operation for finding micro-metastasis in patients with cutaneous melanoma without evidence of clinically positive lymph node findings. However, until now, no clinical trials or retrospective studies with large samples have been performed to investigate the clinical role of SLNB for cutaneous melanoma patients. In this study, we used the data of cutaneous melanoma from the Surveillance, Epidemiology, and End Results (SEER) database to compare overall survival (OS) and melanoma-specific survival (MSS) outcomes with clinical lymph node and SLN status. In total, 56,285 eligible patients were identified in this study. Cutaneous melanoma patients with clinically-positive lymph nodes had significantly shorter OS (46.1% vs 78.6%, p = 0.000) and MSS (55.8% vs 90.5, p = 0.000) compared with clinically-negative lymph node patients. Patients who underwent SLNB had significantly longer 5-year rates for OS (84.3% vs 70.1, p = 0.000) and MSS (91.5% vs 90.3, p = 0.000) compared with patients who did not undergo SLNB (lymph node observation). Patients with a negative SLNB had a significantly longer 5-year rate for OS (86.5% vs 68.1% vs 46.1, p = 0.000) and MSS (93.7% vs 75.1% 55.8%, p = 0.000) than patients who were SLNB-positive or had clinically-positive lymph nodes. This present study showed that the status of SLN is a valuable prognostic factor in patients with Breslow thickness greater than 1 mm in clinically-negative lymph node cutaneous melanoma.
Collapse
Affiliation(s)
- Jie Chen
- Department of Gastric Cancer and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Yu Xu
- Department of Gastric Cancer and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Ye Zhou
- Department of Gastric Cancer and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Yanong Wang
- Department of Gastric Cancer and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Huiyan Zhu
- Department of Gastric Cancer and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Yingqiang Shi
- Department of Gastric Cancer and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| |
Collapse
|
25
|
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.
Collapse
|
26
|
Egger ME, Bhutiani N, Farmer RW, Stromberg AJ, Martin RCG, Quillo AR, McMasters KM, Scoggins CR. Prognostic factors in melanoma patients with tumor-negative sentinel lymph nodes. Surgery 2016; 159:1412-21. [PMID: 26775577 DOI: 10.1016/j.surg.2015.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 11/24/2015] [Accepted: 12/05/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Sentinel lymph node (SLN) biopsy for melanoma results in accurate nodal staging, which guides treatment decisions. Patients with a negative SLN biopsy in general have a favorable prognosis, but certain subsets are at increased risk for recurrence and death. This study aimed to identify risk factors predictive of prognosis in patients with a tumor-negative SLN biopsy for cutaneous melanoma. METHODS In this post-hoc analysis of data from a multicenter prospective randomized trial, clinicopathologic data of patients with cutaneous melanoma ≥1.0 mm Breslow thickness and tumor-negative SLN were analyzed. Disease-free survival, overall survival (OS), and local and in-transit recurrence-free survival were compared by Kaplan-Meier analysis. Risk factors for worse survival were identified with Cox proportional hazard models. RESULTS This analysis included 1,998 patients with tumor-negative SLN with a median follow-up of 70 months. Ulceration, Breslow thickness, nonextremity tumor location, and age ≥45 years were independent risk factors for worse disease-free survival and OS. Breslow thickness and ulceration were the only factors on multivariate analysis that predicted local and in-transit recurrence-free survival. Estimated 5-year OS rates ranged from 55.5 to 95.4% on the basis of the defined risk factors. CONCLUSION There is a wide range of prognosis among patients with tumor-negative SLN. Breslow thickness, ulceration, age, and anatomic location of the primary melanoma are important independent factors predicting survival and recurrence among such patients. These factors can be used to stratify prognosis among patients with tumor-negative SLN to formulate rational long-term follow-up strategies as well as identify high-risk, SLN-negative patients for clinical trials of adjuvant therapy.
Collapse
Affiliation(s)
- Michael E Egger
- Hiram C. Polk, Jr., MD Department of Surgery, University of Louisville, Louisville, KY
| | - Neal Bhutiani
- Hiram C. Polk, Jr., MD Department of Surgery, University of Louisville, Louisville, KY
| | - Russell W Farmer
- Hiram C. Polk, Jr., MD Department of Surgery, University of Louisville, Louisville, KY
| | | | - Robert C G Martin
- Hiram C. Polk, Jr., MD Department of Surgery, University of Louisville, Louisville, KY
| | - Amy R Quillo
- Hiram C. Polk, Jr., MD Department of Surgery, University of Louisville, Louisville, KY
| | - Kelly M McMasters
- Hiram C. Polk, Jr., MD Department of Surgery, University of Louisville, Louisville, KY
| | - Charles R Scoggins
- Hiram C. Polk, Jr., MD Department of Surgery, University of Louisville, Louisville, KY.
| |
Collapse
|
27
|
Lee DY, Huynh KT, Teng A, Lau BJ, Vitug S, Lee JH, Stern SL, Foshag LJ, Faries MB. Predictors and Survival Impact of False-Negative Sentinel Nodes in Melanoma. Ann Surg Oncol 2015; 23:1012-8. [PMID: 26586498 DOI: 10.1245/s10434-015-4912-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND The status of the sentinel lymph node in melanoma is an important prognostic factor. The clinical predictors and implications of false-negative (FN) biopsy remain debatable. METHODS We compared patients with positive sentinel lymph node biopsy (SNB) [true positive (TP)] and negative SNB with and without regional recurrence [FN, true negative (TN)] from our prospective institutional database. RESULTS Among 2986 patients (84 FN, 494 TP, and 2408 TN; median follow-up 93 months), the incidence of FN-SNB was 2.8%. While calculated FN rate was 14.5% [84 FN/(494 TP + 84 FN) × 100], when we accounted for local/in-transit recurrence (LITR) this rate was 8.5% [46 FN/(494 TP + 46 FN) × 100 %]. On multivariate analysis, male gender (OR 2.0, 95% CI 1.1-3.6, p = 0.018), head/neck primaries (OR 2.5, 95% CI 1.3-4.8, p < 0.006), and LITR (OR 3.5, 95% CI 2.1-5.8, p < 0.001) were associated with FN-SNB. Melanoma-specific survival (MSS) for the FN group was similar to the TP group at 5 years (68 vs. 73%, p = 0.539). However, MSS declined more for the FN group with a longer follow up and was significantly worse at 10 years (44 vs. 64%, p < 0.001). On multivariate analysis, FN-SNB was a significant predictor of worse MSS in melanomas <4 mm in Breslow thickness (HR 1.6; 95% CI 1.1-2.5, p = 0.021). CONCLUSIONS Male gender, LITR, and head and neck tumors were associated with FN-SNB. FN-SNB was an independent predictor of worse MSS in melanomas <4 mm in thickness, but this survival difference did not become apparent until after 5 years of follow-up.
Collapse
Affiliation(s)
- David Y Lee
- Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA
| | - Kelly T Huynh
- Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA
| | - Annabelle Teng
- Department of Surgery, Mount Sinai, St-Luke's-Roosevelt Hospital Center, New York, NY, USA
| | - Briana J Lau
- Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA
| | - Sarah Vitug
- Ochsner Clinical School, University of Queensland School of Medicine, Saint Lucia, QLD, Australia
| | - Ji-Hey Lee
- Department of Biostatistics, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA
| | - Stacey L Stern
- Department of Biostatistics, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA
| | - Leland J Foshag
- Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA
| | - Mark B Faries
- Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA.
| |
Collapse
|
28
|
Hodges M, Jones E, Jones T, Pearlman N, Gajdos C, Kounalakis N, McCarter M. Analysis of melanoma recurrence following a negative sentinel lymph node biopsy. Melanoma Manag 2015; 2:285-294. [PMID: 30190855 DOI: 10.2217/mmt.15.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Little attention has been paid to the characteristics and outcomes of patients who experience distant, local or regional recurrence of melanoma following a negative sentinel lymph node biopsy. This article aims to review the published literature on the topic and presents some general summaries regarding this patient population. Patients who experience a disease recurrence following a negative sentinel lymph node biopsy have a worse overall survival compared with patients with a positive sentinel lymph node biopsy. The implications and possible explanations for these findings are discussed in order to both underscore the need for in-depth investigation of local, regional or distant melanoma recurrence among patients following a true negative sentinel lymph node biopsy, as well as increased efforts to minimize the rate of false negative sentinel lymph node biopsies.
Collapse
Affiliation(s)
- Maggie Hodges
- Department of Surgery, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Edward Jones
- Department of Surgery, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Teresa Jones
- Department of Surgery, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Nathan Pearlman
- Department of Surgery, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Csaba Gajdos
- Department of Surgery, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Nicole Kounalakis
- Department of Surgery, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Martin McCarter
- Department of Surgery, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, USA
| |
Collapse
|
29
|
Otsuka M, Yamasaki O, Kaji T, Iwatsuki K, Asagoe K. Sentinel lymph node biopsy for 102 patients with primary cutaneous melanoma at a single Japanese institute. J Dermatol 2015; 42:954-61. [DOI: 10.1111/1346-8138.12972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 04/29/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Masaki Otsuka
- Department of Dermatology; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; Okayama Japan
| | - Osamu Yamasaki
- Department of Dermatology; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; Okayama Japan
| | - Tatsuya Kaji
- Department of Dermatology; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; Okayama Japan
| | - Keiji Iwatsuki
- Department of Dermatology; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; Okayama Japan
| | - Kenji Asagoe
- Department of Dermatology; National Hospital Organization Okayama Medical Center; Okayama Japan
| |
Collapse
|
30
|
Tejera-Vaquerizo A, Nagore E, Puig S, Robert C, Saiag P, Martín-Cuevas P, Gallego E, Herrera-Acosta E, Aguilera J, Malvehy J, Carrera C, Cavalcanti A, Rull R, Vilalta-Solsona A, Lannoy E, Boutros C, Benannoune N, Tomasic G, Aegerte P, Vidal-Sicart S, Palou J, Alos LL, Requena C, Traves V, Pla Á, Bolumar I, Soriano V, Guillén C, Herrera-Ceballos E. Effect of time to sentinel-node biopsy on the prognosis of cutaneous melanoma. Eur J Cancer 2015; 51:1780-93. [PMID: 26072362 DOI: 10.1016/j.ejca.2015.05.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 04/26/2015] [Accepted: 05/21/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION In patients with primary cutaneous melanoma, there is generally a delay between excisional biopsy of the primary tumour and sentinel-node biopsy. The objective of this study is to analyse the prognostic implications of this delay. PATIENTS AND METHOD This was an observational, retrospective, cohort study in four tertiary referral hospitals. A total of 1963 patients were included. The factor of interest was the interval between the date of the excisional biopsy of the primary melanoma and the date of the sentinel-node biopsy (delay time) in the prognosis. The primary outcome was melanoma-specific survival and disease-free survival. RESULTS A delay time of 40 days or less (hazard ratio (HR), 1.7; confidence interval (CI), 1.2-2.5) increased Breslow thickness (Breslow ⩾ 2 mm, HR, > 3.7; CI, 1.4-10.7), ulceration (HR, 1.6; CI, 1.1-2.3), sentinel-node metastasis (HR, 2.9; CI, 1.9-4.2), and primary melanoma localised in the head or neck were independently associated with worse melanoma-specific survival (all P < 0.03). The stratified analysis showed that the effect of delay time was at the expense of the patients with a negative sentinel-node biopsy and without regression. CONCLUSION Early sentinel-node biopsy is associated with worse survival in patients with cutaneous melanoma.
Collapse
Affiliation(s)
- Antonio Tejera-Vaquerizo
- Servicio de Dermatología, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria/Universidad de Málaga, Boulevard Louis Pasteur, 32, 29071 Málaga, Spain.
| | - Eduardo Nagore
- Department of Dermatology, Instituto Valenciano de Oncología, c/ Profesor Beltrán Báguena, 8, 46009 Valencia, Spain.
| | - Susana Puig
- Melanoma Unit, Servicio de Dermatología y Anatomía Patológica, Hospital Clínic, Universidad de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, Spain.
| | - Caroline Robert
- Department of Dermatology, Gustave Roussy Cancer Campus, 114 rue Édouard-Vaillant, 94805 Villejuif Cedex, France.
| | - Philippe Saiag
- Service de dermatologie générale et oncologique, Hôpital Ambroise-Paré, Université de Versailles, Boulogne cedex, France.
| | - Paula Martín-Cuevas
- Servicio de Dermatología, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria/Universidad de Málaga, Boulevard Louis Pasteur, 32, 29071 Málaga, Spain.
| | - Elena Gallego
- Servicio de Anatomía Patológica, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria/Universidad de Málaga, Málaga, Boulevard Louis Pasteur, 32, 29071 Málaga, Spain.
| | - Enrique Herrera-Acosta
- Servicio de Dermatología, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria/Universidad de Málaga, Boulevard Louis Pasteur, 32, 29071 Málaga, Spain.
| | - José Aguilera
- Servicio de Dermatología, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria/Universidad de Málaga, Boulevard Louis Pasteur, 32, 29071 Málaga, Spain.
| | - Josep Malvehy
- Melanoma Unit, Servicio de Dermatología y Anatomía Patológica, Hospital Clínic, Universidad de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, Spain.
| | - Cristina Carrera
- Melanoma Unit, Servicio de Dermatología y Anatomía Patológica, Hospital Clínic, Universidad de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, Spain.
| | - Andrea Cavalcanti
- Department of Surgery, Gustave Roussy Cancer Campus, 114 rue Édouard-Vaillant, 94805 Villejuif Cedex, France.
| | - Ramón Rull
- Departamento de Cirugía, Hospital Clínic, Universidad de Barcelona, Villarroel 170, 08036 Barcelona, Spain.
| | - Antonio Vilalta-Solsona
- Melanoma Unit, Servicio de Dermatología y Anatomía Patológica, Hospital Clínic, Universidad de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, Spain.
| | - Emilie Lannoy
- Biostatistics and Epidemiology Unit, Gustave Roussy Cancer Campus, 114 rue Édouard-Vaillant, 94805 Villejuif Cedex, France.
| | - Celine Boutros
- Department of Dermatology, Gustave Roussy Cancer Campus, 114 rue Édouard-Vaillant, 94805 Villejuif Cedex, France.
| | - Naima Benannoune
- Department of Dermatology, Gustave Roussy Cancer Campus, 114 rue Édouard-Vaillant, 94805 Villejuif Cedex, France.
| | - Gorana Tomasic
- Department of Pathology, Gustave Roussy Cancer Campus, 114 rue Édouard-Vaillant, 94805 Villejuif Cedex, France.
| | - Philippe Aegerte
- Service de Biostatistique et Informatique Médicale, Hôpital Ambroise-Paré, Boulogne, France.
| | - Sergi Vidal-Sicart
- Servicio de Medicina Nuclear, Hospital Clínic Barcelona, Universidad de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, Spain.
| | - Josep Palou
- Melanoma Unit, Servicio de Dermatología y Anatomía Patológica, Hospital Clínic, Universidad de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, Spain.
| | - L Lúcia Alos
- Departamento de Anatomía Patológica, Universidad de Barcelona, Villarroel 170, 08036 Barcelona, Spain.
| | - Celia Requena
- Department of Dermatology, Instituto Valenciano de Oncología, c/ Profesor Beltrán Báguena, 8, 46009 Valencia, Spain.
| | - Víctor Traves
- Departamento de Anatomía Patológica, Instituto Valenciano de Oncología, c/ Profesor Beltrán Báguena, 8, 46009 Valencia, Spain.
| | - Ángel Pla
- Departamento de Otorrinolaringología, Instituto Valenciano de Oncología, c/ Profesor Beltrán Báguena, 8, 46009 Valencia, Spain.
| | - Isidro Bolumar
- Departamento de Cirugía, Instituto Valenciano de Oncología, c/ Profesor Beltrán Báguena, 8, 46009 Valencia, Spain.
| | - Virtudes Soriano
- Departamento de Oncología Médica, Instituto Valenciano de Oncología, c/ Profesor Beltrán Báguena, 8, 46009 Valencia, Spain.
| | - Carlos Guillén
- Department of Dermatology, Instituto Valenciano de Oncología, c/ Profesor Beltrán Báguena, 8, 46009 Valencia, Spain.
| | - Enrique Herrera-Ceballos
- Servicio de Dermatología, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria/Universidad de Málaga, Boulevard Louis Pasteur, 32, 29071 Málaga, Spain.
| |
Collapse
|
31
|
Read RL, Haydu L, Saw RPM, Quinn MJ, Shannon K, Spillane AJ, Stretch JR, Scolyer RA, Thompson JF. In-transit melanoma metastases: incidence, prognosis, and the role of lymphadenectomy. Ann Surg Oncol 2014; 22:475-81. [PMID: 25256128 DOI: 10.1245/s10434-014-4100-0] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE To analyze a large, single-institution database to further understanding of melanoma in-transit metastases (ITM) with regard to incidence, prognosis, and the role of lymphadenectomy. METHODS A total of 11,614 patients with single primary cutaneous melanomas were treated at Melanoma Institute Australia between January 1994 and December 2009. Of these, 505 developed ITM. Clinicopathologic characteristics, sentinel node (SN) status, patterns of disease progression, and outcomes were analyzed. RESULTS In the 505 patients with ITM, the median primary tumor thickness was 2.95 mm, and 39.4 % were ulcerated. The ITM rates for patients with primary melanomas <1 or ≥1 mm in size and in those who underwent sentinel node biopsy were 0.4, 7.8, and 7.2 %, respectively. The ITM rates for SN-positive and SN-negative patients were 21.6 and 4.7 %, respectively. The median time from primary diagnosis to the development of ITM was 17.9 months. After ITM diagnosis, the median survival time was 19.9 months, 5-year survival was 32.8 %, and 10-year survival was 27.5 %. After ITM diagnosis, primary tumor site (head/neck, trunk) and ulceration were predictors of poorer survival. Five-year survival from the time of ITM ranged from 47.9 % for nonulcerated limb primary lesions to only 13.6 % for ulcerated trunk primary lesions. Elective lymph node dissection in clinically node-negative patients with ITM did not significantly alter overall survival. CONCLUSIONS This large study demonstrates that the diagnosis of melanoma ITM carries serious adverse prognostic implications and will assist in improving the accuracy of staging and prognostic estimates as well as treatment in these patients.
Collapse
|
32
|
Leong SPL, Tseng WW. Micrometastatic cancer cells in lymph nodes, bone marrow, and blood: Clinical significance and biologic implications. CA Cancer J Clin 2014; 64:195-206. [PMID: 24500995 DOI: 10.3322/caac.21217] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 11/25/2013] [Accepted: 11/25/2013] [Indexed: 01/09/2023] Open
Abstract
Cancer metastasis may be regarded as a progressive process from its inception in the primary tumor microenvironment to distant sites by way of the lymphovascular system. Although this type of tumor dissemination often occurs in an orderly fashion via the sentinel lymph node (SLN), acting as a possible gateway to the regional lymph nodes, bone marrow, and peripheral blood and ultimately to distant metastatic sites, this is not a general rule as tumor cells may enter the blood and spread to distant sites, bypassing the SLN. Methods of detecting micrometastatic cancer cells in the SLN, bone marrow, and peripheral blood of patients have been established. Patients with cancer cells in their SLN, bone marrow, or peripheral blood have worse clinical outcomes than patients with no evidence of spread to these compartments. The presence of these cells also has important biologic implications for disease progression and the clinician's understanding of the process of cancer metastasis. Further characterization of these micrometastatic cancer cells at each stage and site of metastasis is needed to design novel selective therapies for a more "personalized" treatment.
Collapse
Affiliation(s)
- Stanley P L Leong
- Chief of Cutaneous Oncology, Associate Director of the Melanoma Program, Center for Melanoma Research and Treatment, California Pacific Medical Center and Sutter Pacific Medical Foundation, Senior Scientist, California Pacific Medical Center Research Institute, San Francisco, CA
| | | |
Collapse
|
33
|
Scheri RP, Essner R. Lymphatic mapping and sentinel lymphadenectomy in primary cutaneous melanoma. Expert Rev Anticancer Ther 2014; 6:1105-10. [PMID: 16831081 DOI: 10.1586/14737140.6.7.1105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The management of clinically normal regional lymph nodes in early-stage melanoma has been controversial for over 100 years. Lymphatic mapping and sentinel lymphadenectomy has been developed as a minimally invasive surgical technique to stage regional lymph nodes without the associated morbidity of complete lymph node dissection. Multiple retrospective studies have validated the accuracy of lymphatic mapping and sentinel lymphadenectomy and the importance of the sentinel lymph node as a prognostic tool for melanoma. Several multicenter, prospective, randomized trials are underway to validate the data of the Phase II studies and determine the therapeutic benefit of lymphatic mapping and sentinel lymphadenectomy.
Collapse
Affiliation(s)
- Randall P Scheri
- Division of Surgical Oncology, John Wayne Cancer Institute, 2200 Santa Monica Boulevard, Santa Monica, CA 90404, USA.
| | | |
Collapse
|
34
|
Wang AX, Qi XY. Targeting RAS/RAF/MEK/ERK signaling in metastatic melanoma. IUBMB Life 2013; 65:748-58. [PMID: 23893853 DOI: 10.1002/iub.1193] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 05/26/2013] [Accepted: 06/03/2013] [Indexed: 12/13/2022]
Affiliation(s)
- Ao-Xue Wang
- Department of Dermatology; The Second Affiliated Hospital of Dalian Medical University; Dalian; People's Republic of China
| | - Xiao-Yi Qi
- Department of Dermatology; The Second Affiliated Hospital of Dalian Medical University; Dalian; People's Republic of China
| |
Collapse
|
35
|
Bello DM, Chou JF, Panageas KS, Brady MS, Coit DG, Carvajal RD, Ariyan CE. Prognosis of acral melanoma: a series of 281 patients. Ann Surg Oncol 2013; 20:3618-25. [PMID: 23838913 DOI: 10.1245/s10434-013-3089-0] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND Acral melanoma (AM) is an unusual malignancy with poor survival. This study defines a cohort of patients, treated at a single institution, and the factors associated with survival and comparison with nonacral cutaneous melanoma (NACM). METHODS All patients with AM presenting from 1995 to 2010 were identified from a prospectively maintained database. Analysis of clinicopathologic features of AM associated with disease-specific survival (DSS) was performed. A stratified, stage-matched survival analysis compared the outcome of 281 acral to 843 extremity NACM patients. RESULTS A total of 281 AM patients (170 volar, 111 subungual) were identified. Pathologic stage (p < 0.001), ulceration (p < 0.001), Breslow thickness (p < 0.001), and a positive sentinel lymph node (p < 0.001) were found to be poor prognostic indicators associated with DSS. In stage-matched analysis, AM had a worse DSS compared with NACM (hazard ratio 1.8; 95 % CI 1.2-2.7; p < 0.01). CONCLUSIONS This study represents the largest, single-institution series describing the characteristics and outcomes of AM. AM tumors exhibit aggressive histopathologic features associated with a poorer survival outcome. AM patients have an inferior survival than extremity NACM when matched for stage, perhaps reflecting inherent alterations in tumor biology. This warrants further investigation into the differences between acral and cutaneous melanoma.
Collapse
Affiliation(s)
- Danielle M Bello
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | | | | | | | | | | |
Collapse
|
36
|
Fadaki N, Li R, Parrett B, Sanders G, Thummala S, Martineau L, Cardona-Huerta S, Miranda S, Cheng ST, Miller JR, Singer M, Cleaver JE, Kashani-Sabet M, Leong SPL. Is head and neck melanoma different from trunk and extremity melanomas with respect to sentinel lymph node status and clinical outcome? Ann Surg Oncol 2013; 20:3089-97. [PMID: 23649930 DOI: 10.1245/s10434-013-2977-7] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Previous studies showed conflicting and inconsistent results regarding the effect of anatomic location of the melanoma on sentinel lymph node (SLN) positivity and/or survival. This study was conducted to evaluate and compare the effect of the anatomic locations of primary melanoma on long-term clinical outcomes. METHODS All consecutive cutaneous melanoma patients (n=2,079) who underwent selective SLN dissection (SLND) from 1993 to 2009 in a single academic tertiary-care medical center were included. SLN positive rate, disease-free survival (DFS), and overall survival (OS) were determined. Kaplan-Meier survival, univariate, and multivariate analyses were performed to determine predictive factors for SLN status, DFS, and OS. RESULTS Head and neck melanoma (HNM) had the lowest SLN-positive rate at 10.8% (16.8% for extremity and 19.3% for trunk; P=0.002) but had the worst 5-year DFS (P<0.0001) and 5-year OS (P<0.0001) compared with other sites. Tumor thickness (P<0.001), ulceration (P<0.001), HNM location (P=0.001), mitotic rate (P<0.001), and decreasing age (P<0.001) were independent predictive factors for SLN-positivity. HNM with T3 or T4 thickness had significantly lower SLN positive rate compared with other locations (P≤0.05). Also, on multivariate analysis, HNM location versus other anatomic sites was independently predictive of decreased DFS and OS (P<0.001). By Kaplan-Meier analysis, HNM was associated significantly with the worst DFS and OS. CONCLUSIONS Primary melanoma anatomic location is an independent predictor of SLN status and survival. Although HNM has a decreased SLN-positivity rate, it shows a significantly increased risk of recurrence and death as compared with other sites.
Collapse
Affiliation(s)
- Niloofar Fadaki
- Center for Melanoma Research & Treatment, California Pacific Medical Center, San Francisco, CA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Grossmann AH, Grossmann KF, Wallander ML. Molecular testing in malignant melanoma. Diagn Cytopathol 2012; 40:503-10. [PMID: 22619125 DOI: 10.1002/dc.22810] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Molecular testing of cancers to determine therapeutic eligibility is now standard of care and has changed the practice of pathology. Recent advances in the treatment of metastatic melanoma with BRAF and KIT inhibitors have increased the demand for molecular testing in melanoma. Furthermore, rapid progress is being made in determining potential new targets, mechanisms of resistance, and developing additional rationally designed therapies. The likely consequence will be a significant expansion of molecular testing for melanoma to include an array of multiple signaling intermediates. Currently, routine testing is mostly limited to BRAF and KIT. Mutations in these genes generally occur in a distinct group of melanoma subsets though, and with the numerous techniques available for mutation analysis, decisions about testing can be complex. The purpose of this review is to provide an overview of clinically relevant mutations which currently guide systemic therapy in Stage IV melanoma, how these molecular events vary with melanoma subtype and primary site of origin, and practical recommendations for testing.
Collapse
Affiliation(s)
- Allie H Grossmann
- Department of Pathology, ARUP Laboratories, University of Utah, Salt Lake City, Utah, USA
| | | | | |
Collapse
|
38
|
McDonald K, Page AJ, Jordan SW, Chu C, Hestley A, Delman KA, Murray DR, Carlson GW. Analysis of regional recurrence after negative sentinel lymph node biopsy for head and neck melanoma. Head Neck 2012; 35:667-71. [DOI: 10.1002/hed.23013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2012] [Indexed: 11/08/2022] Open
|
39
|
Murali R, DeSilva C, McCarthy SW, Thompson JF, Scolyer RA. Sentinel lymph nodes containing very small (<0.1 mm) deposits of metastatic melanoma cannot be safely regarded as tumor-negative. Ann Surg Oncol 2012; 19:1089-99. [PMID: 22271204 DOI: 10.1245/s10434-011-2208-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Indexed: 01/26/2023]
Abstract
BACKGROUND Some authors have suggested that patients with very small (<0.1 mm) deposits of metastatic melanoma in sentinel lymph nodes (SLNs) should be considered SLN-negative, whereas others have reported that such patients can have adverse long-term outcomes. The aims of the present study were to determine whether extensive sectioning of SLNs resulted in more accurate categorization of histologic features of tumor deposits and to assess prognostic associations of histologic parameters obtained using more intensive sectioning protocols. METHODS From patients with a single primary cutaneous melanoma who underwent SLN biopsy between 1991 and 2008, those in which the maximum size of the largest tumor deposit (MaxSize) in SLNs was <0.1 mm in the original sections were identified. Five batches of additional sections were cut from the SLN tissue blocks at intervals of 250 μm. The 1st batch was cut from the blocks without any trimming; these sections were therefore immediately adjacent to the original sections. Each batch included 5 sequential sections, the 1st and 5th stained with hematoxylin-eosin, and the 2nd, 3rd, and 4th stained immunohistochemically with S-100, HMB-45, and Melan-A, respectively. In each batch of sections, the following histologic features of tumor deposit(s) in the SLNs were evaluated: MaxSize; tumor penetrative depth (TPD) (defined as the maximum depth of tumor deposit(s) from the inner margin of the lymph node capsule), and intranodal location (classified as subcapsular if the tumor deposit(s) were confined to the subcapsular zone or parenchymal if there was any involvement of the nodal parenchyma beyond the subcapsular zone). The measured histologic parameters were compared in each batch of sections. The association of histologic parameters with overall survival was assessed for the parameters measured in each batch of sections. RESULTS There were 20 eligible patients (15 females, 5 males, median age 60 years). After a median follow-up duration of 40 months, 4 patients had died from melanoma and 2 patients of unknown causes. Completion lymph node dissection (CLND) was performed in 13 cases (65%) and was negative in all cases. Relative to the measured values on the original sections, all 3 parameters were upstaged in subsequent batches of sections, but no further upstaging of MaxSize, TPD, or location was seen beyond batch 3, batch 4, and batch 2, respectively. Increasing MaxSize was associated with significantly poorer overall survival in batches 1, 2, and 3. Parenchymal involvement was significantly associated with poorer survival in batches 2-5. TPD was not significantly associated with overall survival. CONCLUSIONS The results of this study indicate that very small (<0.1 mm) deposits of melanoma in SLNs may be associated with adverse clinical outcomes and that this is due, at least in part, to the underestimation of SLN tumor burden in the initial sections. Our evidence does not support clinical decision-making on the assumption that patients with very small melanoma deposits in SLNs have the same outcome as those who are SLN-negative.
Collapse
Affiliation(s)
- Rajmohan Murali
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, and Discipline of Pathology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
| | | | | | | | | |
Collapse
|
40
|
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.
Collapse
|
41
|
Rondelli F, Vedovati M, Becattini C, Tomassini G, Messina S, Noya G, Simonetti S, Covarelli P. Prognostic role of sentinel node biopsy in patients with thick melanoma: a meta-analysis. J Eur Acad Dermatol Venereol 2011; 26:560-5. [DOI: 10.1111/j.1468-3083.2011.04109.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
42
|
Veenstra HJ, Wouters MJ, Kroon BB, Olmos RAV, Nieweg OE. Less false-negative sentinel node procedures in melanoma patients with experience and proper collaboration. J Surg Oncol 2011; 104:454-7. [DOI: 10.1002/jso.21967] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Accepted: 04/06/2011] [Indexed: 01/05/2023]
|
43
|
Valsecchi ME, Silbermins D, de Rosa N, Wong SL, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in patients with melanoma: a meta-analysis. J Clin Oncol 2011; 29:1479-87. [PMID: 21383281 DOI: 10.1200/jco.2010.33.1884] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To perform a meta-analysis of all published studies of sentinel lymph node (SLN) biopsy for staging patients with melanoma. METHODS Published literature in all languages between 1990 and 2009 was critically appraised. Primary outcomes evaluated included the proportion successfully mapped (PSM) and test performance including false-negative rate (FNR), post-test probability negative (PTPN), and positive predictive value in the same nodal basin recurrence. RESULTS A total of 71 studies including 25,240 patients met full eligibility criteria. The average PSM was 98.1% (95% CI, 97.3% to 98.6%) and increased with the year of publication, female sex, ulceration, age, and the quality score of the studies. The FNR ranged from 0.0% to 34.0%, averaging 12.5% overall (95% CI, 11% to 14.2%). FNR increased with the length of follow-up (P = .002) but decreased with greater PSM (P = .001). PTPN averaged 3.4% (95% CI, 3.0% to 3.8%), which also increased in studies with longer follow-up, younger age, female sex, deeper Breslow thickness, and with tumor ulceration while decreasing with greater PSM (P < .001). Approximately 20% of the patients with a positive SLN had additional lymph nodes in the complete lymph node dissection and 7.5% of the patients with positive SLN developed recurrence in the same nodal basin which was greater in studies that also reported higher FNR (P = .01). CONCLUSION The estimated risk of nodal recurrence after a negative SLN biopsy was ≤ 5% supporting the use of this technology for staging patients with melanoma.
Collapse
|
44
|
Scolyer RA, Murali R, McCarthy SW, Thompson JF. Histologically ambiguous ("borderline") primary cutaneous melanocytic tumors: approaches to patient management including the roles of molecular testing and sentinel lymph node biopsy. Arch Pathol Lab Med 2011; 134:1770-7. [PMID: 21128774 DOI: 10.5858/2009-0612-rar.1] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
It is well recognized that the pathologic diagnosis of melanocytic tumors can sometimes be difficult. For some atypical melanocytic tumors that do not display clear-cut features of malignancy, it may be difficult or impossible to exclude a diagnosis of melanoma; this includes those showing some resemblance to Spitz nevi, blue nevi, deep penetrating nevi, and possible nevoid melanomas. When there is uncertainty about whether a primary melanocytic tumor is a nevus or a melanoma, we recommend that a second opinion be sought from one or more experienced colleagues. If diagnostic uncertainty persists, the evidence for or against the various differential diagnostic considerations should be presented in the pathology report and a "most likely" or "favored" diagnosis given. Molecular testing of the primary tumor by using techniques such as comparative genomic hybridization or fluorescence in situ hybridization may assist in establishing a diagnosis of melanoma if multiple chromosomal aberrations are identified. However, these tests require further independent validation and are not widely available at present. Complete excision of the lesion is probably mandatory, but plans for further management should be formulated on a case-by-case basis. While the safest course of action will usually be to manage the tumor as if it were a melanoma (taking into account the tumor's thickness and other prognostic variables), this may not always be appropriate, particularly if it is located in a cosmetically sensitive site such as the face. In some cases, it may be appropriate for the surgical oncologist to convey the diagnostic uncertainty to patients and to present them with management choices so that they can decide whether they wish to be managed aggressively (as for a melanoma) or conservatively. While a sentinel lymph node biopsy may be recommended on the basis of the primary tumor characteristics, the clinical significance of lymph node involvement for these tumors is not yet clear, and it may not have the same prognostic implications as nodal involvement from an unequivocal "conventional" melanoma.
Collapse
|
45
|
Nicholl MB, Elashoff D, Takeuchi H, Morton DL, Hoon DSB. Molecular upstaging based on paraffin-embedded sentinel lymph nodes: ten-year follow-up confirms prognostic utility in melanoma patients. Ann Surg 2011; 253:116-22. [PMID: 21135695 PMCID: PMC3046555 DOI: 10.1097/sla.0b013e3181fca894] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine the long-term clinical significance of molecular upstaging in histopathology-negative, paraffin-embedded (PE) sentinel lymph nodes (SLNs) from melanoma patients. BACKGROUND Histopathologic evaluation can miss clinically relevant melanoma micrometastases in SLNs. This longitudinal correlative study is the first 10-year prognostic evaluation of a multimarker quantitative real-time reverse transcriptase-polymerase chain reaction (qRT) assay for PE melanoma-draining SLNs. METHODS The SLN sections (n = 214) were assessed by qRT assay for 4 established messenger RNA biomarkers: MART-1, MAGE-A3, GalNAc-T, and PAX3. RESULTS The qRT assay upstaged 48 of 161 histopathology-negative (hematoxylin-eosin and immunohistochemistry) SLN specimens. At a median follow-up of 11.3 years for the entire cohort, estimated rates of 10-year overall survival (OS) and melanoma-specific survival (MSS) were 82% and 94%, respectively, for histopathology-negative/qRT-negative patients; 56% and 61%, respectively, for histopathology-positive patients; and 52% and 60%, respectively, for histopathology-negative/qRT-positive patients (P < 0.001 for OS, P < 0.001 for MSS). In a multivariate analysis of known melanoma prognostic factors, qRT positivity was significant (P < 0.05) for disease-free survival (hazard ratio [HR], 4.3; 95% confidence interval (CI), 2.3-7.8), distant disease-free survival (HR, 6.6; 95% CI, 2.9-14.6), MSS (HR, 6.2; 95% CI, 2.6-14.4), and OS (HR, 2.8; 95% CI, 1.6-4.9). CONCLUSION The multimarker qRT assay has prognostic significance for molecular upstaging of PE melanoma-draining SLNs. Molecular upstaging of histopathology-negative SLNs confers a prognosis similar to that associated with SLN micrometastasis, and the number of positive qRT biomarkers is correlated to disease outcome.
Collapse
Affiliation(s)
- Michael B. Nicholl
- Department of Molecular Oncology, John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, CA
- Division of Surgical Oncology, John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, CA
| | - David Elashoff
- Division of Biostatistics, John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, CA
| | - Hiroya Takeuchi
- Department of Molecular Oncology, John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, CA
| | - Donald L. Morton
- Division of Surgical Oncology, John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, CA
| | - Dave S. B. Hoon
- Department of Molecular Oncology, John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, CA
| |
Collapse
|
46
|
Murali R, Shaw HM, Lai K, McCarthy SW, Quinn MJ, Stretch JR, Thompson JF, Scolyer RA. Prognostic factors in cutaneous desmoplastic melanoma: a study of 252 patients. Cancer 2010; 116:4130-8. [PMID: 20564101 DOI: 10.1002/cncr.25148] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Desmoplastic melanoma (DM) is a rare subtype of melanoma that is characterized by malignant spindle cells separated by prominent, fibrocollagenous stroma. Primary melanomas either may be entirely desmoplastic or almost entirely desmoplastic (pure DM [pDM]) or may exhibit a desmoplastic component admixed with a nondesmoplastic component (combined DM [cDM]). METHODS Patients who were diagnosed between 1993 and 2007 at a single institution with clinically localized, primary cutaneous melanoma (PCM) that contained a desmoplastic component and who underwent sentinel lymph node (SLN) biopsy were identified. Clinical and pathologic features of the primary tumors were correlated with DM type, SLN status, and patient outcome. RESULTS Two hundred fifty-two patients (167 men, 85 women) were identified (median age, 61 years). The median tumor thickness was 2.0 mm. One hundred twenty-three patients (48.8%) had pDM, and 129 patients (51.2%) had cDM. Overall, 17 patients (6.7%) had positive SLN status, including 12 patients with cDM and 5 patients with pDM. Because of the low SLN-positive rate, a statistically significant difference in SLN status between patients with cDM (8.5%) and patients with pDM (4.9%; P = .25) could not be demonstrated. Older patient age, being a man, positive SLN status, and increasing tumor thickness were associated significantly with poorer disease-free survival (P < .05), although only the latter 2 variables were independently predictive. In addition, cDM type (P = .017) was associated significantly and independently with a shorter time to recurrence. CONCLUSIONS In this largest study to date of patients with DM who underwent SLN biopsy, the SLN-positive rate in patients with DM was lower than that in patients with conventional melanoma. The results indicated that DM type is associated significantly and independently with the time to recurrence and should be evaluated routinely in all patients with PCM. Cancer 2010. (c) 2010 American Cancer Society.
Collapse
Affiliation(s)
- Rajmohan Murali
- Diagnostic Oncology and Tissue Pathology, Royal Prince Alfred Hospital, Camperdown, Sydney, New South Wales, Australia.
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Panasiti V, Devirgiliis V, Curzio M, Roberti V, Gobbi S, Rossi M, Bottoni U, Clerico R, Scuderi N, Calvieri S. Predictive Factors for False Negative Sentinel Lymph Node in Melanoma Patients. Dermatol Surg 2010; 36:1521-8. [DOI: 10.1111/j.1524-4725.2010.01676.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
48
|
EORTC Melanoma Group sentinel node protocol identifies high rate of submicrometastases according to Rotterdam Criteria. Eur J Cancer 2010; 46:2414-21. [DOI: 10.1016/j.ejca.2010.06.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 05/28/2010] [Accepted: 06/02/2010] [Indexed: 11/23/2022]
|
49
|
van Akkooi ACJ, Verhoef C, Eggermont AMM. Importance of tumor load in the sentinel node in melanoma: clinical dilemmas. Nat Rev Clin Oncol 2010; 7:446-54. [PMID: 20567244 DOI: 10.1038/nrclinonc.2010.100] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
There are two hypotheses to explain melanoma dissemination: first, simultaneous lymphatic and hematogeneous spread, with regional lymph nodes as indicators of metastatic disease; and second, orderly progression, with regional lymph nodes as governors of metastatic disease. The sentinel node (SN) has been defined as the first draining lymph node from a tumor and is harvested with the use of the triple technique and is processed by an extensive pathology protocol. The SN status is a strong prognostic factor for survival (83-94% for SN negative, 56-75% SN-positive patients). False-negative rates are considerable (9-21%). Preliminary results of the MSLT-1 trial did not demonstrate a survival benefit for the SN procedure, although a subgroup analysis indicates a possible benefit. A mathematical model has demonstrated 24% prognostic false positivity. SN tumor burden represents a heterogeneous patient population and is classified most frequently with the Starz, Dewar or Rotterdam Criteria. A completion lymph-node dissection might not be indicated in all SN-positive patients. Patients classified with metastases <0.1 mm by the Rotterdam Criteria have excellent survival rates. Ultrasound-guided fine-needle aspiration cytology is emerging as a staging tool for high-risk patients, but more research is necessary before this can change clinical practice.
Collapse
Affiliation(s)
- Alexander C J van Akkooi
- Department of Surgical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Groene Hilledijk 301, Kamer A1-41, 3075 EA Rotterdam, The Netherlands.
| | | | | |
Collapse
|
50
|
Richtig E, Komericki P, Trapp M, Ott A, Bisail B, Egger JW, Zalaudek I. Ratio of marked and excised sentinel lymph nodes and scintigraphic appearance time in melanoma patients with negative sentinel lymph node. Eur J Surg Oncol 2010; 36:783-8. [PMID: 20510570 DOI: 10.1016/j.ejso.2010.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 03/31/2010] [Accepted: 05/04/2010] [Indexed: 10/19/2022] Open
Abstract
AIM Metastases can occur in up to 15% of all melanoma patients with negative sentinel lymph node examination (SN -). We retrospectively investigated the number of preoperatively marked sentinel lymph nodes (SNs) with lymphoscintigraphy and effectively surgically removed SNs in SN--patients with cutaneous melanoma >or=0.5 mm. Ratio of these parameters was calculated and impact of this ratio as well as impact of scintigraphic appearance time (SAT) on disease progression was studied. MATERIALS AND METHODS Data on 122 SN--patients--70 women (58%), mean age 56.5 years--were analyzed. Mean follow-up time was 58 months. RESULTS Mean tumour thickness of all patients was 2.3 mm. In 51 patients (42%) the number of SNs marked in lymphoscintigraphy was higher than excised in surgery, in 47 patients (38%) the same number as marked was excised and in 24 patients (20%) a lower number was marked than excised. Metastases occurred in 17 patients (14%) after a mean time of 24.8 months. Mean tumour thickness (5.4 mm) was significantly higher in these patients than in the other patients (p = 0.000). Ratio of marked and excised SNs had no influence on disease progression; the only parameter influencing outcome was tumour thickness (p = 0.000). Short SAT was significantly associated with higher tumour thickness (p = 0.004). CONCLUSION Our study indicates that, in routine clinical practice, it suffices to harvest the first SN, as the ratio of marked and excised SNs has no impact on disease progression.
Collapse
Affiliation(s)
- E Richtig
- Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, 8036 Graz, Austria.
| | | | | | | | | | | | | |
Collapse
|