Abstract
BackgroundSentinel node biopsy (SNB) is an important step in melanoma staging and prognostication. It is commonly performed for patients with intermediate thickness melanomas, based on clinicopathological features. However, only 20–25% of patients eventually demonstrate nodal involvement. The aim of this study was to evaluate whether tissue biomarkers with links to melanoma biology, together with clinicopathological parameters, could aid in the prediction of sentinel node involvement and improve selection of patients for SNB. In addition, we examined the role of these clinical or biological markers in disease outcome.MethodsWe collected a case-control cohort of 140 intermediate thickness (Breslow 0,9–4,0mm) melanoma patients with or without SNB involvement matched for age, gender, Breslow thickness and location. From this cohort, we tested the predictive value of common clinicopathological parameters (ulceration, mitotic count and tumor regression) and FMNL-2, ezrin and BRAF V600E immunoreactivity, for sentinel node involvement and survival. We further analyzed the correlations in the superficial spreading melanoma subtype.ResultsBased on our case control analysis, of the markers, BRAF V600E status (p = 0.010) and mitotic count (p = 0.036) correlated with SNB involvement. SNB status was a strong independent prognosticator for recurrence free survival (RFS p<0.001), melanoma specific survival (MSS p = 0.000) and overall survival (OS p = 0.029). In the superficially spreading melanoma subgroup, BRAF V600E positivity indicated poorer RFS (p = 0.039) and OS (p = 0.012). By combining the Breslow thickness, mitotic count and BRAF immunohistochemistry, we identified a group of superficially spreading melanomas with an excellent survival probability independent of SNB status.ConclusionsThese results demonstrate that BRAF immunohistochemistry could serve as a useful addition to a marker panel for selecting intermediate thickness melanoma patients for SNB.
Highlights
Cutaneous melanoma is a common malignant neoplasia with over 230 000 cases and 55 000 cancer deaths annually [1]
These results demonstrate that BRAF immunohistochemistry could serve as a useful addition to a marker panel for selecting intermediate thickness melanoma patients for sentinel node biopsy (SNB)
There is a clear need for markers that would improve the preoperative identification of sentinel lymph node positive/negative patients for targeting individuals for SNB
Summary
Cutaneous melanoma is a common malignant neoplasia with over 230 000 cases and 55 000 cancer deaths annually [1]. Standard of care in the intermediate thickness (1.0–4.0 mm Breslow) melanoma includes radical excision of the primary tumor and concomitant SNB. In this patient group, only 20–25% of patients have affected sentinel lymph nodes. There is a clear need for markers that would improve the preoperative identification of sentinel lymph node positive/negative patients for targeting individuals for SNB. Sentinel node biopsy (SNB) is an important step in melanoma staging and prognostication It is commonly performed for patients with intermediate thickness melanomas, based on clinicopathological features. We examined the role of these clinical or biological markers in disease outcome
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