Sentinel lymph node tumor load: An independent predictor of additional lymph node involvement and survival in melanoma

Ronald J.C.L.M. Vuylsteke, Paul J. Borgstein, Paul A.M. Van Leeuwen, Hester A. Gietema, Barbara G. Molenkamp, Markwin G.Statius Muller, Paul J. Van Diest, Joost R.M. Van Der Sijp, Sybren Meijer

Research output: Contribution to journalArticle

Abstract

Even though 60% to 80% of melanoma patients with a positive sentinel lymph node (SLN) have no positive additional lymph nodes (ALNs), all these patients are subjected to an ALN dissection (ALND) with its associated morbidity. The aim of this study was to predict the absence of ALN metastases in patients with a positive SLN by using features of the primary melanoma and SLN tumor load. Of 71 SLN-positive patients, 52 had metastasis limited to the SLN (group 1), and 19 had 1 positive ALN after ALND (group 2). The tumor load of the SLN was assessed by measuring the total surface area by computerized morphometry. Breslow thickness, ulceration and lymphatic invasion of the primary tumor, and total SLN metastatic area were tested as covariates predicting the absence of positive ALNs. The mean SLN metastatic area was 1.18 mm2 (group 1) and 3.39 mm2 (group 2) (P = .003) and was the only significant and independent factor after multivariate analysis (P = .02). None of the patients with both a Breslow thickness <2.5 mm and an SLN metastatic area <.3 mm2 had a positive ALN. SLN metastatic area can be used to predict the absence of positive ALNs in melanoma patients. In this study, patients with a Breslow thickness <2.5 mm and an SLN tumor load <.3 mm2 seemed to have no positive ALN and had excellent survival. We hypothesize that this subgroup might not benefit from ALND. Prospective larger trials, using this model and randomizing between ALND and no ALND, should confirm this hypothesis.

Original languageEnglish (US)
Pages (from-to)440-448
Number of pages9
JournalAnnals of surgical oncology
Volume12
Issue number6
DOIs
StatePublished - Jun 1 2005

Keywords

  • Additional lymph node
  • Melanoma
  • Metastatic area
  • Sentinel lymph node

ASJC Scopus subject areas

  • Surgery
  • Oncology

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  • Cite this

    Vuylsteke, R. J. C. L. M., Borgstein, P. J., Van Leeuwen, P. A. M., Gietema, H. A., Molenkamp, B. G., Muller, M. G. S., Van Diest, P. J., Van Der Sijp, J. R. M., & Meijer, S. (2005). Sentinel lymph node tumor load: An independent predictor of additional lymph node involvement and survival in melanoma. Annals of surgical oncology, 12(6), 440-448. https://doi.org/10.1245/ASO.2005.06.013