Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 146 No. 3940 (2016)

Prognostic value of sentinel lymph node biopsy in melanomas of different Breslow’s thickness

  • S. Morteza Seyed Jafari
  • Pitschna Jäckle
  • Aude Michel
  • Sarina Angermeier
  • Robert Hunger
  • Maziar Shafighi
DOI
https://doi.org/10.4414/smw.2016.14358
Cite this as:
Swiss Med Wkly. 2016;146:w14358
Published
29.09.2016

Abstract

BACKGROUND: Although sentinel lymph node biopsy (SLNB) is the most sensitive and accurate investigative modality for establishing regional node status in patients with melanoma, its role and benefit in melanoma of different Breslow’s thickness is still controversial.

OBJECTIVE: The current study aimed mainly to evaluate the effects of SLNB results on important outcome parameters in primary melanomas with different Breslow’s thicknesses.

METHODS: In a retrospective cohort (1990 to 2014), all cases of single, primary localised cutaneous melanoma tumours were evaluated. Data collected consisted of tumour location, tumour type, ulceration, Breslow’s thickness and SLNB result. In addition, locoregional recurrence, distant metastases, disease-free and overall survival were used as the important parameters to compare outcome among the various groups in the current study.

RESULTS: A total of 1111 patients (527 female, 584 male; mean age 64.33 ± 15.44 years) were considered in the analyses in this study, with mean follow-up of 22 77.3 days. The multivariate Cox analysis showed that age, ulceration, Breslow’s depth and SLNB result significantly decreased disease-free survival. This analysis also demonstrated that age, gender, ulceration, Breslow’s depth and SLNB result significantly affected overall survival. Furthermore, the Kaplan-Meier method showed that the patients with negative SLNB had longer disease-free survival than the patients with positive SLNB in thin, intermediate and thick melanomas (p <0.001, p <0.001 and p = 0.008, respectively). Additionally, in the patients with intermediate melanomas significant better overall survival outcome was observed in those with negative SLNB (p <0.001). Despite worse mean overall survival of the patients with thin or thick melanomas and positive SLNB compared with the patients with negative SLNB, this difference was not statistically significant (p = 0.077 and p = 0.13, respectively).

CONCLUSION: Sentinel lymph node biopsy of melanomas provides important prognostic information and the outcome provides additional information for the management and treatment of the patient.

References

  1. Garbe C, Peris K, Hauschild A, Saiag P, Middleton M, Spatz A, et al. Diagnosis and treatment of melanoma. European consensus-based interdisciplinary guideline – Update 2012. Eur J Cancer. 2012;48(15):2375–90.
  2. Sladden MJ, Balch C, Barzilai DA, Berg D, Freiman A, Handiside T, et al. Surgical excision margins for primary cutaneous melanoma. Cochrane Database Syst Rev. 2009;4.
  3. Heppt MV, Reinholz M, Tietze JK, Kerl K, French LE, Berking C, et al. Clinicopathologic features of primary cutaneous melanoma: a single centre analysis of a Swiss regional population. Eur J Dermatol. 2015;25(2):127–32.
  4. Bennàssar A, Ishioka P, Vilalta A. Surgical treatment of primary melanoma. Dermatol Ther. 2012;25(5):432–42.
  5. Lens M, Dawes M. Global perspectives of contemporary epidemiological trends of cutaneous malignant melanoma. Br J Dermatol. 2004;150(2):179–85.
  6. Bouchardy C, Lutz J-M, Kühni C. Cancer in Switzerland, Situation and development from 1983 to 2007. 2011.
  7. Morton DL, Cochran AJ, Thompson JF, Elashoff R, Essner R, Glass EC, et al. Sentinel node biopsy for early-stage melanoma: accuracy and morbidity in MSLT-I, an international multicenter trial. Ann Surg. 2005;242(3):302–11.
  8. 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(11):1479–87.
  9. Balch CM, Soong SJ, Gershenwald JE, Thompson JF, Reintgen DS, Cascinelli N, et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol. 2001;19(16):3622–34.
  10. Fairbairn NG, Orfaniotis G, Butterworth M. Sentinel lymph node biopsy in thick malignant melanoma: a 10-year single unit experience. J Plast Reconstr Aesthet Surg. 2012;65(10):1396–402.
  11. Hunger RE, Michel A, Seyed Jafari SM, Shafighi M. Sentinel lymph node biopsy in thick malignant melanoma: A 16-year single unit experience. Eur J Dermatol. 2015;25(5):472–6.
  12. Fujisawa Y, Otsuka F, Japanese Melanoma Study G. The benefit of a sentinel lymph node biopsy and adjuvant therapy in thick (>4 mm) melanoma: multicenter, retrospective study of 291 Japanese patients. Melanoma Res. 2012;22(5):362–7.
  13. Coit DG, Andtbacka R, Anker CJ, Bichakjian CK, Carson WE 3rd, Daud A, et al. Melanoma. J Natl Compr Canc Netw. 2012;10(3):366–400.
  14. Squires MH, 3rd, Delman KA. Current treatment of locoregional recurrence of melanoma. Curr Oncol Rep. 2013;15(5):465–72.
  15. Grotz TE, Glorioso JM, Pockaj BA, Harmsen WS, Jakub JW. Preservation of the deep muscular fascia and locoregional control in melanoma. Surgery. 2013;153(4):535–41.
  16. Karakousis CP, Balch CM, Urist MM, Ross MM, Smith TJ, Bartolucci AA. Local recurrence in malignant melanoma: long-term results of the multiinstitutional randomized surgical trial. Ann Surg Oncol. 1996;3(5):446–52.
  17. Balch CM, Gershenwald JE, Soong SJ, Thompson JF, Atkins MB, Byrd DR, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27(36):6199–206.
  18. Hunger RE, Seyed Jafari SM, Angermeier S, Shafighi M. Excision of fascia in melanoma thicker than 2 mm: no evidence for improved clinical outcome. Br J Dermatol. 2014;171(6):1391–6.
  19. Hunger RE, Angermeier S, Seyed Jafari SM, Ochsenbein A, Shafighi M. A retrospective study of 1- versus 2-cm excision margins for cutaneous malignant melanomas thicker than 2 mm. J Am Acad Dermatol. 2015;72(6):1054–9.
  20. Gillgren P, Drzewiecki KT, Niin M, Gullestad HP, Hellborg H, Månsson-Brahme E, et al. 2-cm versus 4-cm surgical excision margins for primary cutaneous melanoma thicker than 2 mm: a randomised, multicentre trial. Lancet. 2011;378(98.03):1635–42.
  21. Hudson LE, Maithel SK, Carlson GW, Rizzo M, Murray DR, Hestley AC, et al. 1 or 2 cm margins of excision for T2 melanomas: do they impact recurrence or survival? Ann Surg Oncol. 2013;20(1):346–51.
  22. Kyrgidis A, Tzellos T, Mocellin S, Apalla Z, Lallas A, Pilati P, et al. Sentinel lymph node biopsy followed by lymph node dissection for localised primary cutaneous melanoma. Cochrane Database Syst Rev. 2015;5:Cd010307.
  23. Ross MI. Sentinel node biopsy for melanoma: an update after two decades of experience. Semin Cutan Med Surg. 2010;29(4):238–48.
  24. Morton DL. Lymphatic mapping and sentinel lymphadenectomy for melanoma: past, present, and future. Ann Surg Oncol. 2001;8(9 Suppl):22S–28S.
  25. Ranieri JM, Wagner JD, Wenck S, Johnson CS, Coleman JJ 3rd. The prognostic importance of sentinel lymph node biopsy in thin melanoma. Ann Surg Oncol. 2006;13(7):927–32.
  26. Gajdos C, Griffith KA, Wong SL, Johnson TM, Chang AE, Cimmino VM, et al. Is there a benefit to sentinel lymph node biopsy in patients with T4 melanoma? Cancer. 2009;115(24):5752–60.
  27. Gershenwald JE, Mansfield PF, Lee JE, Ross MI. Role for lymphatic mapping and sentinel lymph node biopsy in patients with thick (> or = 4 mm) primary melanoma. Ann Surg Oncol. 2000;7(2):160–5.
  28. Scoggins CR, Bowen AL, Martin RC 2nd, Edwards MJ, Reintgen DS, Ross MI, et al. Prognostic information from sentinel lymph node biopsy in patients with thick melanoma. Arch Surg. 2010;145(7):622–7.
  29. Jacobs IA, Chang CK, Salti GI. Role of sentinel lymph node biopsy in patients with thick (>4 mm) primary melanoma. Am Surg. 2004;70(1):59–62.
  30. Corsetti RL, Allen HM, Wanebo HJ. Thin < or = 1 mm level III and IV melanomas are higher risk lesions for regional failure and warrant sentinel lymph node biopsy. Ann Surg Oncol. 2000;7(6):456–60.
  31. Bedrosian I, Faries MB, Guerry D 4th, Elenitsas R, Schuchter L, Mick R, et al. Incidence of sentinel node metastasis in patients with thin primary melanoma (< or = 1 mm) with vertical growth phase. Ann Surg Oncol. 2000;7(4):262–7.
  32. Lowe JB, Hurst E, Moley JF, Cornelius LA. Sentinel lymph node biopsy in patients with thin melanoma. Arch Dermatol. 2003;139(5):617–21.
  33. Jacobs IA, Chang CK, DasGupta TK, Salti GI. Role of sentinel lymph node biopsy in patients with thin (<1 mm) primary melanoma. Ann Surg Oncol. 2003;10(5):558–61.
  34. Nahabedian MY, Tufaro AP, Manson PN. Sentinel lymph node biopsy for the T1 (thin) melanoma: is it necessary? Ann Plast Surg. 2003;50(6):601–6.
  35. Warycha MA, Zakrzewski J, Ni Q, Shapiro RL, Berman RS, Pavlick AC, et al. Meta-analysis of sentinel lymph node positivity in thin melanoma (
  36. Joyce KM, McInerney NM, Joyce CW, Jones DM, Hussey AJ, Donnellan P, et al. A review of sentinel lymph node biopsy for thin melanoma. Ir J Med Sci. 2015;184(1):119–23.
  37. Green AC, Baade P, Coory M, Aitken JF, Smithers M. Population-based 20-year survival among people diagnosed with thin melanomas in Queensland, Australia. J Clin Oncol. 2012;30(13):1462–7.
  38. Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Nieweg OE, Roses DF, et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med. 2014;370(7):599–609.
  39. Wright BE, Scheri RP, Ye X, Faries MB, Turner RR, Essner R, et al. Importance of sentinel lymph node biopsy in patients with thin melanoma. Arch Surg. 2008;143(9):892–9.
  40. Mozzillo N, Pennacchioli E, Gandini S, Caracò C, Crispo A, Botti G, et al. Sentinel node biopsy in thin and thick melanoma. Ann Surg Oncol. 2013;20(8):2780–6.
  41. Wong SL, Brady MS, Busam KJ, Coit DG. Results of sentinel lymph node biopsy in patients with thin melanoma. Ann Surg Oncol. 2006;13(3):302–9.
  42. Phan GQ, Messina JL, Sondak VK, Zager JS. Sentinel lymph node biopsy for melanoma: indications and rationale. Cancer Control. 2009;16(3):234–9.
  43. Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Elashoff R, Essner R, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355(13):1307–17.
  44. Martinez SR, Shah DR, Yang AD, Canter RJ, Maverakis E. Sentinel lymph node biopsy in patients with thick primary cutaneous melanoma: patterns of use and underuse utilizing a population-based model. ISRN Dermatol. 2013;2013:315609.
  45. Gershenwald JE, Ross MI. Sentinel-lymph-node biopsy for cutaneous melanoma. N Engl J Med. 2011;364(18):1738–45.
  46. Covarelli P, Vedovati MC, Becattini C, Rondelli F, Tomassini GM, Messina S, et al. The sentinel node biopsy in patients with thick melanoma: outcome analysis from a single-institution database. In vivo. 2011;25(3):439–43.
  47. Ra JH, McMasters KM, Spitz FR. Should all melanoma patients undergo sentinel lymph node biopsy? Curr Opin Oncol. 2006;18(2):185–8.
  48. Marsden JR, Newton-Bishop JA, Burrows L, Cook M, Corrie PG, Cox NH, et al. Revised UK guidelines for the management of cutaneous melanoma 2010. J Plast Reconstr Aesthet Surg. 2010;63(9):1401–19.
  49. Thompson JF, Shaw HM. The prognosis of patients with thick primary melanomas: is regional lymph node status relevant, and does removing positive regional nodes influence outcome? Ann Surg Oncol. 2002;9(8):719–22.
  50. Perrott RE, Glass LF, Reintgen DS, Fenske NA. Reassessing the role of lymphatic mapping and sentinel lymphadenectomy in the management of cutaneous malignant melanoma. J Am Acad Dermatol. 2003;49(4):567–88.
  51. Gutzmer R, Al Ghazal M, Geerlings H, Kapp A. Sentinel node biopsy in melanoma delays recurrence but does not change melanoma-related survival: a retrospective analysis of 673 patients. Br J Dermatol. 2005;153(6):1137–41.
  52. Carlson GW, Murray DR, Hestley A, Staley CA, Lyles RH, Cohen C. Sentinel lymph node mapping for thick (>or=4-mm) melanoma: should we be doing it? Ann Surg Oncol. 2003;10(4):408–15.
  53. Rughani MG, Swan MC, Adams TS, Marshall A, Asher R, Cassell OC, et al. Sentinel node status predicts survival in thick melanomas: the Oxford perspective. Eur J Surg Oncol. 2012;38(10):936–42.
  54. Ferrone CR, Panageas KS, Busam K, Brady MS, Coit DG. Multivariate prognostic model for patients with thick cutaneous melanoma: importance of sentinel lymph node status. Ann Surg Oncol. 2002;9(7):637–45.
  55. Merkow J, Paniccia A, Jones E, Jones T, Hodges M, Stovall R, et al. Association of sentinel lymph node diameter with melanoma metastasis. Am J Surg. 2016;S0002-9610(16)30011–3.
  56. Mocellin S, Lens MB, Pasquali S, Pilati P, Chiarion Sileni V. Interferon alpha for the adjuvant treatment of cutaneous melanoma. Cochrane Database Syst Rev. 2013;(6):CD008955.

Most read articles by the same author(s)