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Prognostic Significance of Sentinel Lymph Node Status in Thick Primary Melanomas (> 4 mm)

Holmberg, Carl-Jacob ; Mikiver, Rasmus ; Isaksson, Karolin LU ; Ingvar, Christian LU ; Moncrieff, Marc ; Nielsen, Kari LU orcid ; Ny, Lars ; Lyth, Johan and Olofsson Bagge, Roger LU (2023) In Annals of Surgical Oncology 30(13). p.8026-8033
Abstract

BACKGROUND: The key prognostic factors for staging patients with primary cutaneous melanoma are Breslow thickness, ulceration, and sentinel lymph node (SLN) status. The multicenter selective lymphadenectomy trial (MSLT-I) verified SLN status as the most important prognostic factor for patients with intermediate-thickness melanoma (Breslow thickness, 1-4 mm). Although most international guidelines recommend SLN biopsy (SLNB) also for patients with thick (> 4 mm, pT4) melanomas, its prognostic role has been questioned. The primary aim of this study was to establish whether SLN status is prognostic in T4 melanoma tumors.

METHODS: Data for all patients with a diagnosis of primary invasive cutaneous melanoma of Breslow thickness... (More)

BACKGROUND: The key prognostic factors for staging patients with primary cutaneous melanoma are Breslow thickness, ulceration, and sentinel lymph node (SLN) status. The multicenter selective lymphadenectomy trial (MSLT-I) verified SLN status as the most important prognostic factor for patients with intermediate-thickness melanoma (Breslow thickness, 1-4 mm). Although most international guidelines recommend SLN biopsy (SLNB) also for patients with thick (> 4 mm, pT4) melanomas, its prognostic role has been questioned. The primary aim of this study was to establish whether SLN status is prognostic in T4 melanoma tumors.

METHODS: Data for all patients with a diagnosis of primary invasive cutaneous melanoma of Breslow thickness greater than 1 mm in Sweden between 2007 and 2020 were retrieved from the Swedish Melanoma Registry, a large prospective population-based registry. A multivariable Cox proportional hazard model for melanoma-specific survival (MSS) was constructed based on Breslow thickness stratified for SLN status.

RESULTS: The study enrolled 10,491 patients, 1943 of whom had a Breslow thickness greater than 4 mm (pT4). A positive SLN was found for 34% of these pT4 patients. The 5-year MSS was 71%, and the 10-year MSS was 62%. There was a statistically significant difference in MSS between the patients with a positive SLN and those with a negative SLN (hazard ratio of 2.4 (95% confidence interval CI 1.6-3.5) for stage T4a and 2.0 (95% CI 1.6-2.5) for satage T4b.

CONCLUSION: Sentinel lymph node status gives important prognostic information also for patients with thick (> 4 mm) melanomas, and the authors thus recommend that clinical guidelines be updated to reflect this.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Annals of Surgical Oncology
volume
30
issue
13
pages
8026 - 8033
publisher
Springer
external identifiers
  • scopus:85167832991
  • pmid:37574516
ISSN
1534-4681
DOI
10.1245/s10434-023-14050-w
language
English
LU publication?
yes
additional info
© 2023. The Author(s).
id
44e67cf5-0035-40a4-8f27-69da8651f699
date added to LUP
2023-10-12 08:38:36
date last changed
2024-04-19 02:14:14
@article{44e67cf5-0035-40a4-8f27-69da8651f699,
  abstract     = {{<p>BACKGROUND: The key prognostic factors for staging patients with primary cutaneous melanoma are Breslow thickness, ulceration, and sentinel lymph node (SLN) status. The multicenter selective lymphadenectomy trial (MSLT-I) verified SLN status as the most important prognostic factor for patients with intermediate-thickness melanoma (Breslow thickness, 1-4 mm). Although most international guidelines recommend SLN biopsy (SLNB) also for patients with thick (&gt; 4 mm, pT4) melanomas, its prognostic role has been questioned. The primary aim of this study was to establish whether SLN status is prognostic in T4 melanoma tumors.</p><p>METHODS: Data for all patients with a diagnosis of primary invasive cutaneous melanoma of Breslow thickness greater than 1 mm in Sweden between 2007 and 2020 were retrieved from the Swedish Melanoma Registry, a large prospective population-based registry. A multivariable Cox proportional hazard model for melanoma-specific survival (MSS) was constructed based on Breslow thickness stratified for SLN status.</p><p>RESULTS: The study enrolled 10,491 patients, 1943 of whom had a Breslow thickness greater than 4 mm (pT4). A positive SLN was found for 34% of these pT4 patients. The 5-year MSS was 71%, and the 10-year MSS was 62%. There was a statistically significant difference in MSS between the patients with a positive SLN and those with a negative SLN (hazard ratio of 2.4 (95% confidence interval CI 1.6-3.5) for stage T4a and 2.0 (95% CI 1.6-2.5) for satage T4b.</p><p>CONCLUSION: Sentinel lymph node status gives important prognostic information also for patients with thick (&gt; 4 mm) melanomas, and the authors thus recommend that clinical guidelines be updated to reflect this.</p>}},
  author       = {{Holmberg, Carl-Jacob and Mikiver, Rasmus and Isaksson, Karolin and Ingvar, Christian and Moncrieff, Marc and Nielsen, Kari and Ny, Lars and Lyth, Johan and Olofsson Bagge, Roger}},
  issn         = {{1534-4681}},
  language     = {{eng}},
  month        = {{08}},
  number       = {{13}},
  pages        = {{8026--8033}},
  publisher    = {{Springer}},
  series       = {{Annals of Surgical Oncology}},
  title        = {{Prognostic Significance of Sentinel Lymph Node Status in Thick Primary Melanomas (> 4 mm)}},
  url          = {{http://dx.doi.org/10.1245/s10434-023-14050-w}},
  doi          = {{10.1245/s10434-023-14050-w}},
  volume       = {{30}},
  year         = {{2023}},
}