Clinical impact of ulceration width, lymphovascular invasion, microscopic satellitosis, perineural invasion, and mitotic rate in patients undergoing sentinel lymph node biopsy for cutaneous melanoma: a retrospective observational study at a comprehensive cancer center.

Kenjiro Namikawa,Jeffrey E Gershenwald,Phyu P Aung,Victor G Prieto,Denái R Milton

doi:10.1002/cam4.1320

Kenjiro Namikawa, Jeffrey E Gershenwald + Show 3 more

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https://doi.org/10.1002/cam4.1320

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Abstract

The prognostic significance of the width of the ulceration in primary melanomas remains unclear, and there is a relative paucity of data for lymphovascular invasion (LVI), microscopic satellitosis (MS), perineural invasion (PNI), and mitotic rate when compared with other pathological elements currently required for reporting. To evaluate the prognostic importance of the ulceration width and other important pathologic measurements, a single‐institutional retrospective study was conducted using records of cutaneous melanoma patients who underwent sentinel lymph node (SLN) biopsy at The University of Texas, MD Anderson Cancer Center between 2003 and 2008. We identified 1898 eligible patients with median tumor thickness of 1.25 mm and median follow‐up of 6.7 years. By multivariable analyses, the strongest risk factor for SLN positivity was high tumor thickness followed by the presence of LVI. The pathologic measures with the strongest influence on recurrence‐free survival (RFS) were tumor thickness and positive SLN status. Ulceration width and presence of MS were also significantly associated with RFS while PNI was not. Factors with the strongest influence on melanoma‐specific survival (MSS) were positive SLN status and mitotic rate. In conclusion, SLN biopsy should probably be offered if the primary tumor has LVI. MS is an adverse prognostic factor for RFS, but its influence on outcome is modest. Ulceration width predicts RFS but loses its independent prognostic significance for MSS when adjusting for currently used clinicopathological factors. In view of its impact on MSS, mitotic rate should be recorded for cutaneous invasive melanomas across all T categories.

Highlights

The accurate assessment and documentation of relevant clinicopathological features are essential for the optimal management of patients with cutaneous melanoma
A larger ulceration width (>7.0 mm) predicted recurrence-free survival (RFS), but did not independently predict sentinel lymph node (SLN) positivity or melanoma-specific survival (MSS) when adjusting for other factors
Association between ulceration width and disease-free survival (DFS)/RFS was consistently significant in both univariate and multivariable analyses [5, 8]

Summary

Introduction

The accurate assessment and documentation of relevant clinicopathological features are essential for the optimal management of patients with cutaneous melanoma. Associations between the presence of lymphovascular invasion (LVI) and SLN positivity/regional nodal involvement were significant in many [11,12,13,14,15,16], but not all [17] studies by univariate analysis, with less clear results in multivariable analyses [13,14,15]. Whether the presence of MS predicts SLN positivity or melanoma-specific survival (MSS) is less clear. The purpose of this study was to evaluate the importance of ulceration width and other important pathological measurements such as LVI, MS, PNI, and mitotic rate in terms of SLN positivity, RFS, and MSS for patients with cutaneous melanoma in the SLN era

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