Influence of Sentinel Lymph Node Tumor Burden on Survival in Melanoma

Thiago Francischetto MD, Nelson Spector MD, PhD, Jose Francisco Neto Rezende MD, Marcelle de Azevedo Antunes MD, Sergio de Oliveira Romano MD, Isabele A. Small, Carlos Gil Ferreira MD, PhD
Melanomas
Volume 17, Issue 4 / April , 2010

View full article HTML | View full article PDF | Download Citation

Abstract

Background

Completion lymph node dissection (CLND) is the standard procedure for patients with positive sentinel lymph nodes (SLN). With extensive pathological workup, increased numbers of small metastatic deposits are detected in SLN. This study evaluated the prognostic significance of SLN metastatic deposits ≤ 0.2 mm in patients treated in a referral cancer center in Brazil.

Methods

Patients with stage I/II melanoma, consecutively submitted to a SLN procedure by the same surgeon from 2000 to 2006, were evaluated. All positive SLN and randomly selected negative cases were reviewed by two pathologists. Different prognostic factors and SLN tumor burden were recorded. Additional positive non-SLN after CLND, and disease outcome were evaluated.

Results

Of 381 patients who underwent SLN biopsy, 103 (27%) were positive. The mean/median Breslow tumor thickness in the overall group was 3.4/2.0 mm and in the SLN positive patients was 5.72/4.0 mm. Among these patients, 48 (47%) had metastatic deposits >2 mm (macrometastasis), 49 (47%) had metastatic deposits ≤2 mm but >0.2 mm (micrometastasis), and 6 (6%) had metastatic deposits ≤0.2 mm (submicrometastasis). Additional positive non-SLN were detected in 29% of patients with macrometastasis, in 25% of patients with micrometastasis, and in 0% of patients with submicrometastases. At median follow-up of 35 months, the estimated 3-year overall survival was 92% for negative SLN, 64% for micrometastases, 53% for macrometastases, and 100% for submicrometastases (P < 0.001).

Conclusion

In the present study, patients with SLN metastatic deposits ≤0.2 mm had no additional positive non-SLNs, and no recurrences or deaths were recorded, suggesting that their prognosis is equivalent to that of patients with negative SLN.

Go to Issue Contents