Abstract
Prognostic markers for nodal metastasis in thin melanoma patients are debated. We present a single institution study looking at factors predictive of nodal disease in thin melanoma patients. Retrospective review from 1997 to 2012 identified 252 patients with thin melanoma (≤1 mm) who underwent a sentinel lymph node biopsy (SLNB). Node‐positive patients included positive SLNB patients and negative SLNB patients who developed a nodal recurrence (false‐negative SLNB). Clinicopathologic characteristics were correlated with nodal status and outcome. Median follow‐up was 45.5 months. Twelve of 252 patients (4.8%) were node‐positive including six positive SLNB (2.4%) and six false‐negative SLNB (2.4%) patients. No clinicopathologic factors were significantly correlated with nodal disease. For the six false‐negative SLNB patients, median time to nodal recurrence was 37.5 months. Regression was seen in only 16% of cases, but the rate increased to 60% for false‐negative SLNB cases. Both age (odds ratio [OR]: 1.09, 95% CI: 1.01–1.17; P = 0.02) and regression (OR: 8.33, 95% CI: 1.34–52.63; P = 0.02) were significantly associated with nodal recurrence after a negative SLNB on univariable analysis. Nodal disease in thin melanoma patients was seen in 4.8% of cases. Although regression was not correlated with nodal metastasis, it was correlated with a false‐negative SLNB. Patients with thin melanoma and regression may need more intensive surveillance after a negative SLNB. Further study is needed to determine if the same immune mechanisms that result in regression in primary tumors also lead to regression in lymph nodes, which may decrease detection of melanoma nodal metastases.
Highlights
The incidence of new melanoma cases in the United States has been rising at an average rate of 1.4% per year [1]
Given the continued controversy over selection criteria for sentinel lymph node biopsy (SLNB) in patients with thin melanoma, and the relatively unknown factors associated with a false-negative SLNB performed in this specific population, we reviewed our experience with SLNB in thin melanoma patients to evaluate for clinicopathologic characteristics associated with the presence of nodal disease and to identify risk factors for a false-negative SLNB
After approval was obtained from the Institutional Review Board, a retrospective review was conducted looking at patients referred to Yale University between 1997 and 2012 who were treated for localized melanoma through wide local excision (WLE) and SLNB
Summary
The incidence of new melanoma cases in the United States has been rising at an average rate of 1.4% per year [1]. The majority (70%) of new melanoma diagnoses consists of thin lesions (≤1 mm). The prognosis is relatively favorable for patients with thin melanoma, with 10-y ear survival rates exceeding 90% [2,3,4]. A subset of thin melanoma patients will experience disease recurrence, not uncommonly greater than 10 years after excision of the primary lesion, and the development of nodal metastasis portends a poorer prognosis [5, 6]. Sentinel lymph node biopsy (SLNB) is recommended to evaluate the draining nodal basins for patients with intermediate thickness melanomas (1 mm to 4 mm) in order to provide powerful staging information [7,8,9]. Neither the National Comprehensive Cancer Network guidelines nor the Society of Surgical Oncology/American Society of Clinical Oncology guidelines
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