Predicting sentinel node status in AJCC stage I/II primary cutaneous melanoma

Authors

  • Laura L. Kruper MD, MSCE,

    Corresponding author
    1. Melanoma Program of the Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
    2. Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
    • Department of Surgery, Hospital of the University of Pennsylvania, 4th Floor Maloney Building, 3400 Spruce St., Philadelphia, PA 19104
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    • Fax: (215) 573-4865

  • Francis R. Spitz MD,

    1. Melanoma Program of the Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
    2. Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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  • Brian J. Czerniecki MD, PHD,

    1. Melanoma Program of the Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
    2. Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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  • Douglas L. Fraker MD,

    1. Melanoma Program of the Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
    2. Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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  • Anne Blackwood-Chirchir MD, MSCE,

    1. Melanoma Program of the Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
    2. Department of Biostatistics and Epidemiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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  • Michael E. Ming MD, MSCE,

    1. Melanoma Program of the Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
    2. Department of Dermatopathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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  • David E. Elder MB, CHB,

    1. Melanoma Program of the Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
    2. Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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  • Rosalie Elenitsas MD,

    1. Melanoma Program of the Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
    2. Department of Dermatopathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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  • DuPont Guerry MD,

    1. Melanoma Program of the Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
    2. Department of Medicine, Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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  • Phyllis A. Gimotty PhD

    1. Melanoma Program of the Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
    2. Department of Biostatistics and Epidemiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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  • Presented in part at the 41st Annual Meeting of the American Society of Clinical Oncology, Orlando, FL, May 13–17, 2005.

Abstract

BACKGROUND.

Sentinel lymph node (SLN) status is an important prognostic factor for survival for patients with primary cutaneous melanoma. To address the issue of selecting patients at high and low risk for a positive SLN, prognostic factors were sought that predict SLN involvement by examining characteristics of both the primary tumor and the patient within the context of a biological model of melanoma progression.

METHODS.

The study included 682 patients with primary vertical growth phase (VGP) melanoma and no clinical evidence of metastatic disease who underwent SLN biopsy (1995–2003). Logistic regression and classification tree analyses were used to investigate the association between SLN positivity and Breslow thickness, Clark level, tumor infiltrating lymphocytes (TIL), ulceration, mitotic rate (MR), lesion site, gender, and age.

RESULTS.

In all, 88 of the 682 patients had ≥1 positive SLN (12.9%). In the multivariate analysis, MR, TIL, and thickness were found to be independent prognostic factors for SLN positivity. In the classification tree, four different risk groups were defined, ranging from minimal risk (2.1%) to high risk (40.4%). In lesions ≤2.0 mm, MR was important in risk-stratifying patients, and in lesions >2.0 mm TIL was important.

CONCLUSIONS.

By incorporating biologically based variables such as VGP, TIL, and MR along with thickness into a prognostic model, both patients at high risk and minimal risk for SLN positivity can be identified. If validated, this model can be used in patient management and trial design to select patients to undergo or be spared SLN biopsy. Cancer 2006. © 2006 American Cancer Society.

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