This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (52)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Neoplasms  • Prognosis/ Outcomes  • Alert me on articles by topic

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.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Validation of a Nomogram to Predict the Presence of Sentinel Lymph Node Metastases in Melanoma
Pinero et al.
Ann. Surg. Oncol. 2008;15:2874-2877.
ABSTRACT | FULL TEXT  

Lymphatic Invasion Identified by Monoclonal Antibody D2-40, Younger Age, and Ulceration: Predictors of Sentinel Lymph Node Involvement in Primary Cutaneous Melanoma
Niakosari et al.
Arch Dermatol 2008;144:462-467.
ABSTRACT | FULL TEXT  

Tumor-Infiltrating Lymphocytes Predict Sentinel Lymph Node Positivity in Patients With Cutaneous Melanoma
Taylor et al.
JCO 2007;25:869-875.
ABSTRACT | FULL TEXT  

Support Vector Machine Learning Model for the Prediction of Sentinel Node Status in Patients With Cutaneous Melanoma
Mocellin et al.
Ann. Surg. Oncol. 2006;13:1113-1122.
ABSTRACT | FULL TEXT  

Predictors of Regional Nodal Disease in Patients With Thin Melanomas
Karakousis et al.
Ann. Surg. Oncol. 2006;13:533-541.
ABSTRACT | FULL TEXT  

Sentinel Lymph Node Biopsy for Cutaneous Melanoma: The Stanford Experience, 1997-2004
Berk et al.
Arch Dermatol 2005;141:1016-1022.
ABSTRACT | FULL TEXT  

Mitotic Rate as a Predictor of Sentinel Lymph Node Positivity in Patients With Thin Melanomas
Kesmodel et al.
Ann. Surg. Oncol. 2005;12:449-458.
ABSTRACT | FULL TEXT  

The Role of Microsatellites as a Prognostic Factor in Primary Malignant Melanoma
Shaikh et al.
Arch Dermatol 2005;141:739-742.
ABSTRACT | FULL TEXT  

Sentinel Node Biopsy Provides More Accurate Staging Than Elective Lymph Node Dissection in Patients With Cutaneous Melanoma
Doubrovsky et al.
Ann. Surg. Oncol. 2004;11:829-836.
ABSTRACT | FULL TEXT  

Mitotic Rate and Younger Age Are Predictors of Sentinel Lymph Node Positivity: Lessons Learned From the Generation of a Probabilistic Model
Sondak et al.
Ann. Surg. Oncol. 2004;11:247-258.
ABSTRACT | FULL TEXT  

NF-{kappa}B in the Vascular Progression of Melanoma
Kashani-Sabet et al.
JCO 2004;22:617-623.
ABSTRACT | FULL TEXT  

Staging Workup, Sentinel Node Biopsy, and Follow-up Tests for Melanoma: Update of Current Concepts
Johnson et al.
Arch Dermatol 2004;140:107-113.
ABSTRACT | FULL TEXT  

Implications of Microscopic Satellites of the Primary and Extracapsular Lymph Node Spread in Patients With High-Risk Melanoma: Pathologic Corollary of Eastern Cooperative Oncology Group Trial E1690
Rao et al.
JCO 2002;20:2053-2057.
ABSTRACT | FULL TEXT  

Vascular Involvement in the Prognosis of Primary Cutaneous Melanoma
Kashani-Sabet et al.
Arch Dermatol 2001;137:1169-1173.
ABSTRACT | FULL TEXT  

Developing Indications for the Use of Sentinel Lymph Node Biopsy and Adjuvant High-Dose Interferon Alfa-2b in Melanoma
Dubois et al.
Arch Dermatol 2001;137:1217-1224.
ABSTRACT | FULL TEXT  

Prognostic Factors Analysis of 17,600 Melanoma Patients: Validation of the American Joint Committee on Cancer Melanoma Staging System
Balch et al.
JCO 2001;19:3622-3634.
ABSTRACT | FULL TEXT  

Final Version of the American Joint Committee on Cancer Staging System for Cutaneous Melanoma
Balch et al.
JCO 2001;19:3635-3648.
ABSTRACT | FULL TEXT  

Treatment of Primary Cutaneous Melanoma
Kanzler and Mraz-Gernhard
JAMA 2001;285:1819-1821.
FULL TEXT  

Cervical Sentinel Lymph Node Biopsy for Melanomas of the Head and Neck and Upper Thorax
Wagner et al.
Arch Otolaryngol Head Neck Surg 2000;126:313-321.
ABSTRACT | FULL TEXT  

Prediction of Lymph Node Metastasis by Histologic Features of Melanoma
Journal Watch Dermatology 1998;1998:2-2.
FULL TEXT