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Serena Mraz-Gernhard, MD; Richard W. Sagebiel, MD; Mohammed Kashani-Sabet, MD; James R. Miller III, PhD; Stanley P. L. Leong, MD

Arch Dermatol. 1998;134:983-987.

Objective  To develop a prognostic model, based on clinical and pathological data, to estimate the probability of micrometastasis in the sentinel lymph node in patients with malignant melanoma.

Design  Retrospective analytical study.

Setting  University medical center.

Patients  Two hundred fifteen patients with American Joint Committee on Cancer stages I and II cutaneous malignant melanoma underwent sentinel lymph node biopsy.

Measurements  Presence of microscopic melanoma in the sentinel lymph node(s). Clinical attributes recorded included age, sex, and location of the primary melanoma. Pathological attributes recorded before lymph node evaluation included ulceration, microsatellites, angiolymphatic invasion, mitotic rate, tumor infiltrating lymphocytes, and regression.

Results  Forty-six patients (21.4%) overall had a positive sentinel lymph node. Patients with tumor thickness ranging from 3.0 to 3.9 mm had the highest incidence (50%) of nodal involvement, followed by those with tumors 4.0 to 4.9 mm thick (41%). Patients with melanomas measuring greater than 4.9 mm thick and those between 1.0 and 2.9 mm had a similar rate of nodal involvement (16%-17%). Clinical characteristics had minimal correlation with nodal status in multivariate analysis. The total number of histological high-risk features was significantly correlated with sentinel lymph node involvement. Important pathological risk factors included ulceration, high mitotic rate, angiolymphatic invasion, and microsatellites. Patients with tumor thickness greater than 1.0 mm but lacking these features had a 14% risk of occult metastases.

Conclusion  Among patients with clinically node-negative primary melanoma, the presence of 1 or more high-risk histological features significantly increases the incidence of microscopic nodal involvement and can be used to predict the likelihood of a positive sentinel lymph node biopsy.

From the Cutaneous Oncology Division, Department of Dermatology (Drs Mraz-Gernhard, Sagebiel, and Kashani-Sabet), Department of Pathology (Dr Sagebiel), and Department of Surgery (Dr Leong), University of California/Mount Zion Medical Center, and the Graduate School of Business, Stanford University and University of California/Mount Zion Medical Center (Dr Miller) San Francisco.

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