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Sentinel lymph node biopsy in patients with T1a cutaneous malignant melanoma: A multicenter cohort study - 14/12/22

Doi : 10.1016/j.jaad.2022.09.040 
Adrienne B. Shannon, MD a, Cimarron E. Sharon, MD a, , Richard J. Straker, MD a, Michael J. Carr, MD, MS b, c, Andrew J. Sinnamon, MD, MSCE b, Kita Bogatch, BA d, Alexandra Thaler, BA a, e, Nicholas Kelly, BA a, e, John T. Vetto, MD f, Graham Fowler, BS f, Danielle DePalo, MD b, Vernon K. Sondak, MD b, John T. Miura, MD a, Mark B. Faries, MD g, Edmund K. Bartlett, MD d, Jonathan S. Zager, MD b, Giorgos C. Karakousis, MD a
a Division of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 
b Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida 
c Department of Surgery, University of Louisville, Louisville, Kentucky 
d Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York 
e Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 
f Division of Surgical Oncology, Department of Surgery, Oregon Health & Science University, Portland, Oregon 
g Division of Surgical Oncology, The Angeles Clinic and Research Institute, Cedars-Sinai Medical Center, Los Angeles, California 

Correspondence to: Cimarron E. Sharon, MD, Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce St, Maloney 4, Philadelphia, PA 19104.Department of SurgeryHospital of the University of Pennsylvania3400 Spruce St, Maloney 4PhiladelphiaPA19104

Abstract

Background

Sentinel lymph node biopsy is not routinely recommended for T1a cutaneous melanoma due to the overall low risk of positivity. Prognostic factors for positive sentinel lymph node (SLN+) in this population are poorly characterized.

Objective

To determine factors associated with SLN+ in patients with T1a melanoma.

Methods

Patients with pathologic T1a (<0.80 mm, nonulcerated) cutaneous melanoma from 5 high-volume melanoma centers from 2001 to 2020 who underwent wide local excision with sentinel lymph node biopsy were included in the study. Patient and tumor characteristics associated with SLN+ were analyzed by univariate and multivariable logistic regression analyses. Age was dichotomized into ≤42 (25% quartile cutoff) and >42 years.

Results

Of the 965 patients identified, the overall SLN+ was 4.4% (N = 43). Factors associated with SLN+ were age ≤42 years (7.5% vs 3.7%; odds ratio [OR], 2.14; P = .03), head/neck primary tumor location (9.2% vs 4%; OR, 2.75; P = .04), lymphovascular invasion (21.4% vs 4.2%; OR, 5.64; P = .01), and ≥2 mitoses/mm2 (8.2% vs 3.4%; OR, 2.31; P = .03). Patients <42 years with ≥2 mitoses/mm2 (N = 38) had a SLN+ rate of 18.4%.

Limitations

Retrospective study.

Conclusion

SLN+ is low in patients with T1a melanomas, but younger age, lymphovascular invasion, mitogenicity, and head/neck primary site appear to confer a higher risk of SLN+.

Le texte complet de cet article est disponible en PDF.

Key words : melanoma, prognosis, sentinel lymph node biopsy, surgery, survival, wide local excision

Abbreviations used : DSS, LVI, OR, PNI, SLN, SLN−, SLN+, SLNB, WLE


Plan


 Drs Zager and Karakousis contributed equally to this article as senior authors.
 Drs Shannon and Sharon contributed equally to this article as first authors.
 Funding sources: Sondak’s relevant financial activities outside the submitted work include BMS, Eisai, Iovance, Novartis, and Regeneron, and he receives research support from Neogene and Turnstone. Bartlett receives institutional research support from SkylineDx and discloses an honorarium from Excite International.
 IRB approval status: Reviewed and determined to be exempt by the University of Pennsylvania IRB, protocol # 843609.
 Patient consent: No identifiable material, including photographs or identifiable medical information, is included in this manuscript. All included data are de-identified, and as such, this manuscript has been determined to be exempt by the IRB.
 Reprints not available from the authors.


© 2022  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 88 - N° 1

P. 52-59 - janvier 2023 Retour au numéro
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