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Tan SX, Chong S, Rowe C, Galbraith J, Dight J, Zhou C, Malt M, Smithers BM, Khosrotehrani K. Lymphatic expression of the proliferation marker Ki67 is linked to sentinel node positivity, recurrence and mortality in primary cutaneous melanoma. Exp Dermatol 2024; 33:e15041. [PMID: 38433382 DOI: 10.1111/exd.15041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 01/12/2024] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Abstract
Lymphangiogenesis is a precursor to lymphovascular invasion, and may therefore signal a higher risk of metastasis and mortality in primary cutaneous melanoma. This retrospective longitudinal study aimed to evaluate whether emergent lymphangiogenesis, as measured through co-expression of endothelial proteins with the proliferation marker Ki67, was associated with poorer prognosis in a cohort of patients with single primary cutaneous melanoma. We screened all patients with a single locally invasive primary cutaneous melanoma who received sentinel lymph node biopsy at a tertiary dermatology centre in Brisbane, Australia between 1994 and 2007. Primary melanoma sections were stained via Opal multiplex immunofluorescence, and categorized according to the presence of Ki67 within either CD31+ or D2-40+ endothelial cells. Multivariate Cox regression modelling was used to evaluate associations between endothelial Ki67 positivity and clinical outcomes, with adjustment for age, sex, Breslow depth, ulceration, and anatomical location. Overall, 264 patients were available for analysis, with a median follow-up duration of 7.1 years. The presence of D2-40+ /Ki67+ co-expression was associated with greater melanoma-specific mortality (adjusted hazard ratio [HR]: 2.03; 95% confidence interval [CI]: 1.33-3.10; p = 0.001) and recurrence (adjusted HR: 1.70; 95% CI: 1.33-3.10; p = 0.001) relative to absence. CD31+ /Ki67+ co-expression was not prognostic in this cohort. Lymphatic proliferation, as measured through D2-40+ /Ki67+ co-expression, predicted greater melanoma-specific mortality and recurrence in this cohort of primary cutaneous melanoma.
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Affiliation(s)
- Samuel X Tan
- Frazer Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Sharene Chong
- Frazer Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Casey Rowe
- Frazer Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Jack Galbraith
- Frazer Institute, University of Queensland, Brisbane, Queensland, Australia
| | - James Dight
- Frazer Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Chenhao Zhou
- Frazer Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Maryrose Malt
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Bernard Mark Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Kiarash Khosrotehrani
- Frazer Institute, University of Queensland, Brisbane, Queensland, Australia
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Kakish H, Lal T, Thuener JE, Bordeaux JS, Mangla A, Rothermel LD, Hoehn RS. Is sentinel lymph node biopsy needed for lentigo maligna melanoma? J Surg Oncol 2024; 129:804-812. [PMID: 38018361 DOI: 10.1002/jso.27543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/05/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND AND OBJECTIVES Sentinel lymph node biopsy (SLNB) is an area of debate in the management of lentigo maligna melanoma (LMM). The utility of SLNB and its prognostic value in LMM have not yet been studied with large databases. METHODS We performed a retrospective review of the National Cancer Database (2012-2020) and the Surveillance, Epidemiology, and End Results (2010-2019) database for patients with cutaneous nonmetastatic LMM with Breslow thickness >1.0 mm. Multivariable logistic regression identified factors associated with SLNB performance and sentinel lymph node (SLN) positivity. Univariable and multivariable analyses assessed overall survival (OS) and melanoma-specific survival (MSS) based on SLNB performance and SLN status. RESULTS Compared to other melanoma subtypes, LMM had lower rates of SLNB (66.6% vs. 80.0%-84.0%) and SLN positivity (11.3% vs. 18.6%-34.2%). Compared to patients who did not undergo SLNB, SLN status was significantly associated with improved OS in patients with SLN positive (HR = 0.64 [0.55-0.76]) and SLN negative (HR = 0.68 [0.49-0.94]), and worse MSS only in patients with positive SLN (HR = 3.93, p < 0.05). CONCLUSION The improved OS associated with SLNB likely implies surgical selection bias. Analysis of MSS confirms appropriate patient selection and suggests important prognostic value associated with SLN status. These results support continued SLNB for LMM patients according to standard guidelines.
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Affiliation(s)
- Hanna Kakish
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Trisha Lal
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jason E Thuener
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jeremy S Bordeaux
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ankit Mangla
- Division of Hematology and Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio, USA
| | - Luke D Rothermel
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Richard S Hoehn
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Jeremić J, Radenović K, Jurišić M, Suđecki B, Marinković M, Mihaljević J, Radosavljević I, Jovanović M, Stojanović M, Milić N, Pavlović V, Stojičić M, Inić Z, Jović M. Primary Melanoma Histopathologic Predictors of Sentinel Lymph Node Positivity: A Proposed Scoring System for Risk Assessment and Patient Selection in a Clinical Setting. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1921. [PMID: 38003969 PMCID: PMC10673032 DOI: 10.3390/medicina59111921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: The careful selection of adequate SLNB candidates not only aims at reducing the surgical risk while identifying SLN metastasis, but also plays a crucial role in identifying the patients eligible for adjuvant therapy. Objectives: The purpose of our study was to investigate the clinical and histologic aspects of primary melanomas that correlate with the likelihood of a positive SLNB result. Materials and Methods: A total of 101 primary melanoma patients who underwent sentinel lymph node biopsies were included in the study. General patient demographics were obtained as well as localization and melanoma-specific characteristics of primary melanoma from histologic reports in addition to data derived from SLNB melanoma histopathology reports. Results: The patients with positive SLN results had a statistically significant increased Breslow thickness (3.8 mm vs. 1.97 mm, p = 0.002), higher mitotic index rate (5/mm2 vs. 2/mm2, p = 0.009), as well as the presence of ulceration (68.4% vs. 31.6%, p = 0.007). Univariate regression analysis showed the Breslow thickness (p = 0.008), the mitotic index rate (p = 0.054), the presence of ulceration (p = 0.009), as well as the pT3-4 stage (p = 0.009) to be significant predictors of SLN positivity. The optimal cut-off values for Breslow thickness and the number of mitoses scores were determined based on ROC curve analysis. Using the Breslow thickness, mitotic index rate, presence of ulceration, and pT3-4 stage significant coefficients from the univariate regression model, a chance prediction score was developed. Conclusions: The newly developed and proposed scoring system can aid in patient selection for SLN biopsy by facilitating a more efficient risk assessment in the detection of lymph node metastases in melanoma patients.
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Affiliation(s)
- Jelena Jeremić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (Z.I.)
| | - Kristina Radenović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
| | - Milana Jurišić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
| | - Branko Suđecki
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
| | - Milana Marinković
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
| | - Jovan Mihaljević
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
| | - Ivan Radosavljević
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
| | - Milan Jovanović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (Z.I.)
| | - Marina Stojanović
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (Z.I.)
- Center for Anesthesia, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Nataša Milić
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (Z.I.)
- Institute for Medical Statistics and Informatics, 11000 Belgrade, Serbia
| | - Vedrana Pavlović
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (Z.I.)
- Institute for Medical Statistics and Informatics, 11000 Belgrade, Serbia
| | - Milan Stojičić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (Z.I.)
| | - Zorka Inić
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (Z.I.)
- Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, 11000 Belgrade, Serbia
| | - Marko Jović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia (I.R.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (Z.I.)
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Knackstedt TJ. Differences in sentinel lymph node biopsy utilization in eligible melanoma patients treated with Mohs micrographic surgery or wide local excision: A population-based logistic regression model and survival analysis. J Am Acad Dermatol 2023; 88:848-855. [PMID: 36368376 DOI: 10.1016/j.jaad.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/14/2022] [Accepted: 11/01/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Primary melanoma management relies on tumor extirpation and staging sentinel lymph node biopsy (SLNB) in eligible patients. This study compares SLNB utilization in patients undergoing wide local excision (WLE) or Mohs micrographic surgery (MMS). METHODS American Joint Committee on Cancer seventh edition ≥ patients with T1b melanoma undergoing WLE or MMS in the Surveillance, Epidemiology, and End Results program were included. Propensity score matching was performed to compare patients who underwent MMS or WLE. Kaplan-Meier analysis and Fine-Gray cumulative incidence functions were used for overall and melanoma-specific survival. RESULTS Eight hundred twenty-five MMS cases and 38,760 WLE cases were identified. SLNB was performed in 32.61% of MMS patients and 61.77% of WLE patients with positive rates of 12.5% and 14.82%, respectively. Multiple logistic regression of factors associated with SLNB utilization revealed that WLE, male gender, younger age, extremity location, and nodular and rare melanoma subtypes were significantly associated with increased odds of receiving SLNB whereas head and neck location and lentigo maligna melanoma subtype were significantly less likely to receive SLNB. LIMITATIONS Potential selection bias from a retrospective data set. CONCLUSION Patients receiving WLE for ≥ T1b melanoma are more likely to receive a SLNB than patients undergoing MMS.
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Affiliation(s)
- Thomas J Knackstedt
- Department of Dermatology, MetroHealth System, Cleveland, Ohio; School of Medicine, Case Western Reserve University, Cleveland, Ohio; Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
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Greene AC, Wong WG, Perez Holguin RA, Patel A, Pameijer CR, Shen C. The Association of Guideline-Concordant Sentinel Lymph Node Biopsy for Melanoma at Minority-Serving Hospitals. Ann Surg Oncol 2023; 30:3634-3645. [PMID: 36935433 DOI: 10.1245/s10434-023-13341-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/19/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Minority-serving hospitals (MSHs) have been associated with lower guideline adherence and worse outcomes for various cancers. However, the relationship among MSH status, concordance with sentinel lymph node biopsy (SLNB) guidelines, and overall survival (OS) for patients with cutaneous melanoma is not well studied. METHODS The National Cancer Database was queried for patients diagnosed with T1a*, T2, and T3 melanoma between 2012 and 2017. MSHs were defined as the top decile of institutions ranked by the proportion of minorities treated for melanoma. Based on National Comprehensive Cancer Network guidelines, guideline-concordant care (GCC) was defined as not undergoing SLNB if thickness was < 0.76 mm without ulceration, mitosis ≥ 1/mm2, or lymphovascular invasion (T1a*), and performing SLNB for patients with intermediate thickness melanomas between 1.0 and 4.0 mm (T2/T3). Multivariable logistic regressions examined associations with GCC. The Kaplan-Meier method and log-rank tests were used to evaluate OS between MSH and non-MSH facilities. RESULTS Overall, 5.9% (N = 2182/36,934) of the overall cohort and 37.8% of minorities (n = 199/527) were managed at MSHs. GCC rates were 89.5% (n = 33,065/36,934) in the overall cohort and 85.4% (n = 450/527) in the minority subgroup. Patients in the overall cohort (odds ratio [OR] 0.85; p = 0.02) and the minority subgroup (OR 0.55; p = 0.02) were less likely to obtain GCC if they received their care at MSHs compared with non-MSHs. Minority patients receiving care at MSHs had a decreased survival compared with those treated at non-MSHs (p = 0.002). CONCLUSIONS Adherence to SLNB guidelines for melanoma was lower at MSHs. Continued focus is needed on equity in melanoma care for minority patients in the United States.
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Affiliation(s)
- Alicia C Greene
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - William G Wong
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Rolfy A Perez Holguin
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Akshilkumar Patel
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Colette R Pameijer
- Division of Surgical Oncology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Chan Shen
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA. .,Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.
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6
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Sentinel lymph node biopsy in patients with T1a cutaneous malignant melanoma: A multicenter cohort study. J Am Acad Dermatol 2023; 88:52-59. [PMID: 36184008 DOI: 10.1016/j.jaad.2022.09.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/15/2022] [Accepted: 09/26/2022] [Indexed: 11/24/2022]
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+.
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Sentinel Lymph Node Biopsy in Cutaneous Melanoma, a Clinical Point of View. Medicina (B Aires) 2022; 58:medicina58111589. [DOI: 10.3390/medicina58111589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Sentinel lymph node biopsy (SLNB) is a surgical procedure that has been used in patients with cutaneous melanoma for nearly 30 years. It is used for both staging and regional disease control with minimum morbidity, as proven by numerous worldwide prospective studies. It has been incorporated in the recommendations of national and professional guidelines. In this article, we provide a summary of the general information on SLNB in the clinical guidelines for the management of cutaneous malignant melanoma (American Association of Dermatology, European Society of Medical Oncology, National Comprehensive Cancer Network, and Cancer Council Australia) and review the most relevant literature to provide an update on the existing recommendations for SLNB.
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The Use and Technique of Sentinel Node Biopsy for Skin Cancer. Plast Reconstr Surg 2022; 149:995e-1008e. [PMID: 35472052 DOI: 10.1097/prs.0000000000009010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand the indications for and prognostic value of sentinel lymph node biopsy in skin cancer. 2. Learn the advantages and disadvantages of various modalities used alone or in combination when performing sentinel lymph node biopsy. 3. Understand how to perform sentinel lymph node biopsy in skin cancer patients. SUMMARY Advances in technique used to perform sentinel lymph node biopsy to assess lymph node status have led to increased accuracy of the procedure and improved patient outcomes.
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Whitman ED, Guenther JM. RE: More sentinel lymph node biopsies for thin melanomas after transition to AJCC 8th edition do not increase positivity rate: A Danish population-based study of 7148 patients. J Surg Oncol 2022; 125:1343-1344. [PMID: 35353374 DOI: 10.1002/jso.26775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Eric D Whitman
- Atlantic Health System Cancer Care, Atlantic Health System, Morristown, New Jersey, USA
| | - J Michael Guenther
- St. Elizabeth Physicians General & Vascular Surgery, Ft. Mitchell, Kentucky, USA
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Huang H, Fu Z, Ji J, Huang J, Long X. Predictive Values of Pathological and Clinical Risk Factors for Positivity of Sentinel Lymph Node Biopsy in Thin Melanoma: A Systematic Review and Meta-Analysis. Front Oncol 2022; 12:817510. [PMID: 35155254 PMCID: PMC8829564 DOI: 10.3389/fonc.2022.817510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background The indications for sentinel lymph node biopsy (SLNB) for thin melanoma are still unclear. This meta-analysis aims to determine the positive rate of SLNB in thin melanoma and to summarize the predictive value of different high-risk features for positive results of SLNB. Methods Four databases were searched for literature on SLNB performed in patients with thin melanoma published between January 2000 and December 2020. The overall positive rate and positive rate of each high-risk feature were calculated and obtained with 95% confidence intervals (CIs). Both unadjusted odds ratios (ORs) and adjusted ORs (AORs) of high-risk features were analyzed. Pooled effects were estimated using random-effects model meta-analyses. Results Sixty-six studies reporting 38,844 patients with thin melanoma who underwent SLNB met the inclusion criteria. The pooled positive rate of SLNB was 5.1% [95% confidence interval (CI) 4.9%-5.3%]. Features significantly predicted a positive result of SLNB were thickness≥0.8 mm [AOR 1.94 (95%CI 1.28-2.95); positive rate 7.0% (95%CI 6.0-8.0%)]; ulceration [AOR 3.09 (95%CI 1.75-5.44); positive rate 4.2% (95%CI 1.8-7.2%)]; mitosis rate >0/mm2 [AOR 1.63 (95%CI 1.13-2.36); positive rate 7.7% (95%CI 6.3-9.1%)]; microsatellites [OR 3.8 (95%CI 1.38-10.47); positive rate 16.6% (95%CI 2.4-36.6%)]; and vertical growth phase [OR 2.76 (95%CI 1.72-4.43); positive rate 8.1% (95%CI 6.3-10.1%)]. Conclusions The overall positive rate of SLNB in thin melanoma was 5.1%. The strongest predictor for SLN positivity identified was microsatellites on unadjusted analysis and ulceration on adjusted analysis. Breslow thickness ≥0.8 mm and mitosis rate >0/mm2 both predict SLN positivity in adjusted analysis and increase the positive rate to 7.0% and 7.7%. We suggest patients with thin melanoma with the above high-risk features should be considered for giving an SLNB.
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Affiliation(s)
- Hanzi Huang
- Department of Plastic Surgery, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ziyao Fu
- Department of Plastic Surgery, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiang Ji
- Department of Plastic Surgery, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiuzuo Huang
- Department of Plastic Surgery, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao Long
- Department of Plastic Surgery, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Sturm B, Creytens D, Smits J, Ooms AHAG, Eijken E, Kurpershoek E, Küsters-Vandevelde HVN, Wauters C, Blokx WAM, van der Laak JAWM. Computer-Aided Assessment of Melanocytic Lesions by Means of a Mitosis Algorithm. Diagnostics (Basel) 2022; 12:diagnostics12020436. [PMID: 35204526 PMCID: PMC8871065 DOI: 10.3390/diagnostics12020436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/31/2021] [Accepted: 01/14/2022] [Indexed: 11/16/2022] Open
Abstract
An increasing number of pathology laboratories are now fully digitised, using whole slide imaging (WSI) for routine diagnostics. WSI paves the road to use artificial intelligence (AI) that will play an increasing role in computer-aided diagnosis (CAD). In melanocytic skin lesions, the presence of a dermal mitosis may be an important clue for an intermediate or a malignant lesion and may indicate worse prognosis. In this study a mitosis algorithm primarily developed for breast carcinoma is applied to melanocytic skin lesions. This study aimed to assess whether the algorithm could be used in diagnosing melanocytic lesions, and to study the added value in diagnosing melanocytic lesions in a practical setting. WSI’s of a set of hematoxylin and eosin (H&E) stained slides of 99 melanocytic lesions (35 nevi, 4 intermediate melanocytic lesions, and 60 malignant melanomas, including 10 nevoid melanomas), for which a consensus diagnosis was reached by three academic pathologists, were subjected to a mitosis algorithm based on AI. Two academic and six general pathologists specialized in dermatopathology examined the WSI cases two times, first without mitosis annotations and after a washout period of at least 2 months with mitosis annotations based on the algorithm. The algorithm indicated true mitosis in lesional cells, i.e., melanocytes, and non-lesional cells, i.e., mainly keratinocytes and inflammatory cells. A high number of false positive mitosis was indicated as well, comprising melanin pigment, sebaceous glands nuclei, and spindle cell nuclei such as stromal cells and neuroid differentiated melanocytes. All but one pathologist reported more often a dermal mitosis with the mitosis algorithm, which on a regular basis, was incorrectly attributed to mitoses from mainly inflammatory cells. The overall concordance of the pathologists with the consensus diagnosis for all cases excluding nevoid melanoma (n = 89) appeared to be comparable with and without the use of AI (89% vs. 90%). However, the concordance increased by using AI in nevoid melanoma cases (n = 10) (75% vs. 68%). This study showed that in general cases, pathologists perform similarly with the aid of a mitosis algorithm developed primarily for breast cancer. In nevoid melanoma cases, pathologists perform better with the algorithm. From this study, it can be learned that pathologists need to be aware of potential pitfalls using CAD on H&E slides, e.g., misinterpreting dermal mitoses in non-melanotic cells.
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Affiliation(s)
- Bart Sturm
- Department of Pathology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
- Pathan B.V., 3045 PM Rotterdam, The Netherlands; (J.S.); (A.H.A.G.O.); (E.K.)
| | - David Creytens
- Department of Pathology, Ghent University Hospital, 9000 Ghent, Belgium;
| | - Jan Smits
- Pathan B.V., 3045 PM Rotterdam, The Netherlands; (J.S.); (A.H.A.G.O.); (E.K.)
| | | | - Erik Eijken
- Laboratory for Pathology Oost Nederland (LabPON), 7550 AM Hengelo, The Netherlands;
| | - Eline Kurpershoek
- Pathan B.V., 3045 PM Rotterdam, The Netherlands; (J.S.); (A.H.A.G.O.); (E.K.)
| | | | - Carla Wauters
- Department of Pathology, Canisius Wilhelmina Hospital, 6500 GS Nijmegen, The Netherlands; (H.V.N.K.-V.); (C.W.)
| | - Willeke A. M. Blokx
- Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands;
| | - Jeroen A. W. M. van der Laak
- Department of Pathology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
- Center for Medical Image Science and Visualization, Linköping University, 581 83 Linköping, Sweden
- Correspondence: ; Tel.: +31-638-814-869
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Molecular Proof of a Clinical Concept: Expression of Estrogen Alpha-, Beta-Receptors and G Protein-Coupled Estrogen Receptor 1 (GPER) in Histologically Assessed Common Nevi, Dysplastic Nevi and Melanomas. Medicina (B Aires) 2021; 57:medicina57111228. [PMID: 34833446 PMCID: PMC8621316 DOI: 10.3390/medicina57111228] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/31/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Objectives: Epidemiologic data show significant differences in melanoma incidence and outcomes between sexes. The role of hormonal receptors in the pathogenesis of melanocytic lesions remains unclear, thus we performed this study aiming to assess estrogen receptors expression in different melanocytic lesions. Materials and Methods: We performed a cross-sectional study that included 73 consecutively excised melanocytic lesions. Estrogen receptor alpha (ERα), beta (ERβ), and G-protein coupled estrogen receptor (GPER) expression was analyzed in melanocytes and keratinocytes of common nevi, dysplastic nevi, melanoma, healthy skin margin, and in sebaceous and sweat gland cells. Results: ERβ expression was higher in dysplastic nevi margin melanocytes compared to common nevi (p = 0.046) and in dysplastic nevi keratinocytes compared to melanoma keratinocytes (p = 0.021). ERβ expression was significantly higher in margin melanocytes compared to melanoma melanocytes (p = 0.009). No difference in ERβ expression was shown between melanocytes of three types of lesions. GPER expression was higher in nuclei and cytoplasm of dysplastic nevi (p = 0.02 and p = 0.036 respectively) and at the margin compared to melanoma. GPER expression was lower in sebaceous glands of tissue surrounding common nevi (p = 0.025) compared to dysplastic nevi. GPER expression was higher in skin margin tissue melanocytes (p = 0.016 nuclear, p = 0.029 cytoplasmic) compared to melanoma melanocytes. There were no differences in ERα expression between the melanocytic lesions. Conclusion: Further large-scale studies are warranted to investigate the potential role of ERβ and GPER in the pathogenesis of melanocytic lesions.
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Weitemeyer MB, Helvind NM, Brinck AM, Hölmich LR, Chakera AH. More sentinel lymph node biopsies for thin melanomas after transition to AJCC 8th edition do not increase positivity rate: A Danish population-based study of 7148 patients. J Surg Oncol 2021; 125:498-508. [PMID: 34672372 DOI: 10.1002/jso.26723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/11/2021] [Accepted: 10/15/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND We evaluated the outcome of sentinel lymph node biopsies (SLNB) in patients with thin melanoma before and after the implementation of AJCC 8th edition (AJCC8) and identified predictors of positive sentinel lymph nodes (+SLN). METHODS Patients diagnosed with T1 melanomas (Breslow thickness ≤1 mm) during 2016-2017 as per AJCC 7th edition (AJCC7) (n = 3414) and 2018-2019 as per AJCC8 (n = 3734) were identified in the Danish Melanoma Database. RESULTS More SLNBs were performed in the AJCC8 cohort compared to the AJCC7 (22.2% vs. 16.2%, p < 0.001), with no significant difference in +SLN rates (4.7% vs. 6.7%, p = 0.118). In the AJCC7 + SLN subgroup, no melanomas were ulcerated, 94.6% had mitotic rate (MR) ≥ 1, 67.6% were ≥0.8 mm and 32.4% would be T1a according to AJCC8. In the AJCC8 + SLN subgroup, 10.3% were ulcerated, 74.4% had MR≥ 1, 97.4% were ≥0.8 mm and 23.1% would be T1a according to AJCC7. On multivariable analysis younger age and MR ≥ 1 were significant predictors of +SLN. CONCLUSION More SLNBs were performed in T1 melanomas after transition to AJCC8 without an increase in +SLN rate. None of the AJCC8 T1b criteria were significant predictors of +SLN. We suggest that mitosis and younger age should be considered as indications for SLNB in thin melanoma.
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Affiliation(s)
- Marie B Weitemeyer
- Department of Plastic and Reconstructive Surgery, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Neel M Helvind
- Department of Plastic and Reconstructive Surgery, Herlev and Gentofte University Hospital, Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Anne M Brinck
- Department of Plastic and Reconstructive Surgery, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Lisbet R Hölmich
- Department of Plastic and Reconstructive Surgery, Herlev and Gentofte University Hospital, Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Annette H Chakera
- Department of Plastic and Reconstructive Surgery, Herlev and Gentofte University Hospital, Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
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14
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Whitman ED, Koshenkov VP, Gastman BR, Lewis D, Hsueh EC, Pak H, Trezona TP, Davidson RS, McPhee M, Guenther JM, Toomey P, Smith FO, Beitsch PD, Lewis JM, Ward A, Young SE, Shah PK, Quick AP, Martin BJ, Zolochevska O, Covington KR, Monzon FA, Goldberg MS, Cook RW, Fleming MD, Hyams DM, Vetto JT. Integrating 31-Gene Expression Profiling With Clinicopathologic Features to Optimize Cutaneous Melanoma Sentinel Lymph Node Metastasis Prediction. JCO Precis Oncol 2021; 5:PO.21.00162. [PMID: 34568719 PMCID: PMC8457832 DOI: 10.1200/po.21.00162] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/22/2021] [Accepted: 08/04/2021] [Indexed: 11/30/2022] Open
Abstract
National guidelines recommend sentinel lymph node biopsy (SLNB) be offered to patients with > 10% likelihood of sentinel lymph node (SLN) positivity. On the other hand, guidelines do not recommend SLNB for patients with T1a tumors without high-risk features who have < 5% likelihood of a positive SLN. However, the decision to perform SLNB is less certain for patients with higher-risk T1 melanomas in which a positive node is expected 5%-10% of the time. We hypothesized that integrating clinicopathologic features with the 31-gene expression profile (31-GEP) score using advanced artificial intelligence techniques would provide more precise SLN risk prediction.
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Affiliation(s)
- Eric D Whitman
- Carol G. Simon Cancer at Morristown Medical Center, Atlantic Health System, Morristown, NJ
| | | | | | - Deri Lewis
- Medical City Dallas Hospital, Dallas, TX
| | - Eddy C Hsueh
- Department of Surgery, St Louis University, St Louis, MO
| | - Ho Pak
- General Surgery Abington Memorial Hospital, Abington, PA
| | | | | | | | | | - Paul Toomey
- Florida State University College of Medicine, Bradenton, FL
| | | | | | - James M Lewis
- University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Andrew Ward
- University of Tennessee Graduate School of Medicine, Knoxville, TN
| | | | | | | | | | | | | | | | | | | | - Martin D Fleming
- Division of Surgical Oncology, The University of Tennessee Health Science Center, Memphis, TN
| | | | - John T Vetto
- Oregon Health & Science University, Portland, OR
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15
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Abstract
Age plays a dynamic role in incidence, presentation, and extent of disease for cutaneous melanoma. Even within the spectrum of juvenile melanoma, there exists a range of spitzoid and nonspitzoid melanocytic and melanoma lesions. Spitzoid melanomas, a more favorable disease in juvenile patients, are malignant lesions and require treatment as such. Lymph node metastases in melanoma occur at lower rates in older patients compared with younger counterparts, yet the rate of metastases is still high. Age appears to play an important role in the development and progression of melanoma, and understanding the differences across age populations is important when counseling patients.
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Affiliation(s)
- Adrienne B Shannon
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 4 Maloney, Philadelphia, PA 19104, USA.
| | - Yun Song
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 4 Maloney, Philadelphia, PA 19104, USA
| | - Xiaowei Xu
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 6 Founders, Philadelphia, PA 19104, USA
| | - Giorgos C Karakousis
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 4 Silverstein, Philadelphia, PA 19104, USA
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16
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MacArthur KM, Baumann BC, Sobanko JF, Etzkorn JR, Shin TM, Higgins HW, Giordano CN, McMurray SL, Krausz A, Newman JG, Rajasekaran K, Cannady SB, Brody RM, Karakousis GC, Miura JT, Cohen JV, Amaravadi RK, Mitchell TC, Schuchter LM, Miller CJ. Compliance with sentinel lymph node biopsy guidelines for invasive melanomas treated with Mohs micrographic surgery. Cancer 2021; 127:3591-3598. [PMID: 34292585 DOI: 10.1002/cncr.33651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/30/2021] [Accepted: 04/21/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) has not been studied for invasive melanomas treated with Mohs micrographic surgery using frozen-section MART-1 immunohistochemical stains (MMS-IHC). The primary objective of this study was to assess the accuracy and compliance with National Comprehensive Cancer Network (NCCN) guidelines for SLNB in a cohort of patients who had invasive melanoma treated with MMS-IHC. METHODS This retrospective cohort study included all patients who had primary, invasive, cutaneous melanomas treated with MMS-IHC at a single academic center between March 2006 and April 2018. The primary outcomes were the rates of documenting discussion and performing SLNB in patients who were eligible based on NCCN guidelines. Secondary outcomes were the rate of identifying the sentinel lymph node and the percentage of positive lymph nodes. RESULTS In total, 667 primary, invasive, cutaneous melanomas (American Joint Committee on Cancer T1a-T4b) were treated with MMS-IHC. The median patient age was 69 years (range, 25-101 years). Ninety-two percent of tumors were located on specialty sites (head and/or neck, hands and/or feet, pretibial leg). Discussion of SLNB was documented for 162 of 176 (92%) SLNB-eligible patients, including 127 of 127 (100%) who had melanomas with a Breslow depth >1 mm. SLNB was performed in 109 of 176 (62%) SLNB-eligible patients, including 102 of 158 melanomas (65%) that met NCCN criteria to discuss and offer SLNB and 7 of 18 melanomas (39%) that met criteria to discuss and consider SLNB. The sentinel lymph node was successfully identified in 98 of 109 patients (90%) and was positive in 6 of those 98 patients (6%). CONCLUSIONS Combining SLNB and MMS-IHC allows full pathologic staging and confirmation of clear microscopic margins before reconstruction of specialty site invasive melanomas. SLNB can be performed accurately and in compliance with consensus guidelines in patients with melanoma using MMS-IHC.
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Affiliation(s)
| | - Brian C Baumann
- Department of Radiation Oncology, Washington University, St Louis, Missouri
| | - Joseph F Sobanko
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Jeremy R Etzkorn
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Thuzar M Shin
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - H William Higgins
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Cerrene N Giordano
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Stacy L McMurray
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Aimee Krausz
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Jason G Newman
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Steven B Cannady
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Robert M Brody
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Giorgos C Karakousis
- Division of Endocrine and Oncologic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - John T Miura
- Division of Endocrine and Oncologic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Justine V Cohen
- Division of Hematology Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Ravi K Amaravadi
- Division of Hematology Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Tara C Mitchell
- Division of Hematology Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Lynn M Schuchter
- Division of Hematology Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Christopher J Miller
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
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17
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Brinker TJ, Kiehl L, Schmitt M, Jutzi TB, Krieghoff-Henning EI, Krahl D, Kutzner H, Gholam P, Haferkamp S, Klode J, Schadendorf D, Hekler A, Fröhling S, Kather JN, Haggenmüller S, von Kalle C, Heppt M, Hilke F, Ghoreschi K, Tiemann M, Wehkamp U, Hauschild A, Weichenthal M, Utikal JS. Deep learning approach to predict sentinel lymph node status directly from routine histology of primary melanoma tumours. Eur J Cancer 2021; 154:227-234. [PMID: 34298373 DOI: 10.1016/j.ejca.2021.05.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 12/28/2022]
Abstract
AIM Sentinel lymph node status is a central prognostic factor for melanomas. However, the surgical excision involves some risks for affected patients. In this study, we therefore aimed to develop a digital biomarker that can predict lymph node metastasis non-invasively from digitised H&E slides of primary melanoma tumours. METHODS A total of 415 H&E slides from primary melanoma tumours with known sentinel node (SN) status from three German university hospitals and one private pathological practice were digitised (150 SN positive/265 SN negative). Two hundred ninety-one slides were used to train artificial neural networks (ANNs). The remaining 124 slides were used to test the ability of the ANNs to predict sentinel status. ANNs were trained and/or tested on data sets that were matched or not matched between SN-positive and SN-negative cases for patient age, ulceration, and tumour thickness, factors that are known to correlate with lymph node status. RESULTS The best accuracy was achieved by an ANN that was trained and tested on unmatched cases (61.8% ± 0.2%) area under the receiver operating characteristic (AUROC). In contrast, ANNs that were trained and/or tested on matched cases achieved (55.0% ± 3.5%) AUROC or less. CONCLUSION Our results indicate that the image classifier can predict lymph node status to some, albeit so far not clinically relevant, extent. It may do so by mostly detecting equivalents of factors on histological slides that are already known to correlate with lymph node status. Our results provide a basis for future research with larger data cohorts.
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Affiliation(s)
- Titus J Brinker
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany.
| | - Lennard Kiehl
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Max Schmitt
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Tanja B Jutzi
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Eva I Krieghoff-Henning
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Dieter Krahl
- Private Laboratory of Dermatohistopathology, Mönchhofstraße 52, 69120, Heidelberg, Germany
| | - Heinz Kutzner
- Dermatopathology Laboratory, Friedrichshafen, Germany
| | - Patrick Gholam
- Department of Dermatology, University Hospital Heidelberg, Heidelberg. Germany
| | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Joachim Klode
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Achim Hekler
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Stefan Fröhling
- Translational Medical Oncology, German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT), 69120, Heidelberg, Germany
| | - Jakob N Kather
- Translational Medical Oncology, German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT), 69120, Heidelberg, Germany; Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - Sarah Haggenmüller
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Christof von Kalle
- Department of Clinical-Translational Sciences, Charité University Medicine and Berlin Institute of Health (BIH), Berlin, Germany
| | - Markus Heppt
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
| | - Franz Hilke
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin, Berlin, Germany
| | - Kamran Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin, Berlin, Germany
| | | | - Ulrike Wehkamp
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Axel Hauschild
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Jochen S Utikal
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany; Department of Dermatology, University Hospital (UKSH), Kiel, Germany
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18
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NAGORE E, MORO R. Surgical procedures in melanoma: recommended deep and lateral margins, indications for sentinel lymph node biopsy, and complete lymph node dissection. Ital J Dermatol Venerol 2021; 156:331-343. [DOI: 10.23736/s2784-8671.20.06776-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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19
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Berghe AS, Cobzac G, Dindelegan G, Șenilă SC, Baican CI, Solomon CM, Rogojan L, Leucuța DC, Drugan TC, Bolboacă SD. Risk factors for positive sentinel lymph node, lymphatic or hematogenous dissemination over time in patients with cutaneous melanoma. Exp Ther Med 2021; 22:730. [PMID: 34055049 PMCID: PMC8145265 DOI: 10.3892/etm.2021.10162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/23/2021] [Indexed: 12/25/2022] Open
Abstract
The aim of the present study was to assess the influence of localization, age or sex and histopathological characteristics upon the chance of developing lymphatic or hematogenous metastatic spread over time, or a positive sentinel lymph node in cutaneous melanoma patients. Patients from the Department of Dermatology, County Emergency Hospital Cluj-Napoca (Cluj-Napoca, Romania), presenting with cutaneous melanoma confirmed histopathologically and a SPECT/CT or lymphoscintigraphic examination to detect the sentinel lymph node, were included in the present study. Our results revealed that Breslow index >2 mm [odds ratio (OR)=4.22, 95% confidence interval (CI) (1.12; 15.93)], presence of ulceration [OR=6.01, 95% CI (1.87; 19.35)], and positive sentinel lymph node [for at least one sentinel lymph node OR=3.58, 95% CI (1.06; 12.04)] were risk factors for hematogenous metastases. All these, except for the Breslow index >2 mm, were demonstrated to be a risk factor for lymphatic spread metastases over time. Ulceration and male sex also represented risk factors for a positive sentinel lymph node, men having a higher risk of developing sentinel lymph nodes than women [adjusted OR=2.27, 95% CI (1.00; 5.13)]. In conclusion, the predictors that influence the occurrence of lymphatic or hematogenous metastases may differ, ulceration and positive sentinel lymph node being common for both types of metastatic spread, while Breslow index being a significant predictor only for hematogenous metastases. Male sex and the presence of ulceration were demonstrated to be significant risk factors for positive sentinel lymph nodes.
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Affiliation(s)
- Alexandra S Berghe
- Department of Medical Informatics and Biostatistics, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Gheorghe Cobzac
- Department of Nuclear Medicine, County Emergency Hospital Cluj-Napoca, 400006 Cluj-Napoca, Romania
| | - George Dindelegan
- Department of Surgery I, 'Iuliu Hațieganu' University of Medicine and Pharmacy, County Emergency Hospital Cluj-Napoca, 400006 Cluj-Napoca, Romania
| | - Simona C Șenilă
- Department of Dermatology, 'Iuliu Hațieganu' University of Medicine and Pharmacy, County Emergency Hospital Cluj-Napoca, 400006 Cluj-Napoca, Romania
| | - Corina I Baican
- Department of Dermatology, 'Iuliu Hațieganu' University of Medicine and Pharmacy, County Emergency Hospital Cluj-Napoca, 400006 Cluj-Napoca, Romania
| | - Carolina M Solomon
- Department of Radiology, 'Iuliu Hațieganu' University of Medicine and Pharmacy, County Emergency Hospital Cluj-Napoca, 400006 Cluj-Napoca, Romania
| | - Liliana Rogojan
- Department of Pathology, County Emergency Hospital Cluj-Napoca, 400006 Cluj-Napoca, Romania
| | - Daniel C Leucuța
- Department of Medical Informatics and Biostatistics, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Tudor C Drugan
- Department of Medical Informatics and Biostatistics, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Sorana D Bolboacă
- Department of Medical Informatics and Biostatistics, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
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Kridin K, Hundt JE, Ludwig RJ, Amber KT, Bitan DT, Cohen AD. Melanoma is associated with an increased risk of bullous pemphigoid: a large population-based longitudinal study. Arch Dermatol Res 2021; 314:77-83. [PMID: 33687539 PMCID: PMC8741710 DOI: 10.1007/s00403-021-02211-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/06/2021] [Accepted: 02/13/2021] [Indexed: 11/26/2022]
Abstract
The association between bullous pemphigoid (BP) and melanoma is yet to be investigated. We aimed to assess assess the bidirectional association between BP and melanoma and to delineate the epidemiological features of patients with both diagnoses. A population-based cohort study was performed comparing BP patients (n = 3924) with age-, sex- and ethnicity-matched control subjects (n = 19,280) with regard to incident cases of melanoma. A case-control design was additionally adopted to estimate the risk of BP in individuals with a preexisting diagnosis of melanoma. The prevalence of preexisting melanoma was higher in patients with BP than in control subjects (1.5% vs. 1.0%, respectively; P = 0.004). A history of melanoma confers a 50% increase in the risk of subsequent BP (OR 1.53; 95% CI 1.14-2.06). This risk was higher among males (OR 1.66; 95% CI 1.09-2.54) and individuals older than 80 years (OR 1.63; 95% CI 1.11-2.38), and persisted after adjustment for multiple putative confounders including PD-1/PDL-1 antagonists (adjusted OR 1.53; 95% CI 1.14-2.06). Conversely, the risk of melanoma among patients with BP was slightly elevated, but did not reach the level of statistical significance (adjusted HR 1.13; 95% CI 0.73-1.74). Patients with a dual diagnosis of BP and melanoma were older at the onset of BP and had lower body mass index. A history of melanoma is associated with a 50% increase in the incidence of subsequent BP. Physicians managing patients with both conditions should be aware of this association. Further research is warranted to reveal the underlying mechanism of these findings.
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Affiliation(s)
- Khalaf Kridin
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
| | - Jennifer E Hundt
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Kyle T Amber
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL, USA
| | - Dana Tzur Bitan
- Department of Behavioral Sciences, Ariel University, Ariel, Israel
| | - Arnon D Cohen
- Clalit Health Services, Tel-Aviv, Israel
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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21
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Kim E, Obermeyer I, Rubin N, Khariwala SS. Prognostic significance of regression and mitotic rate in head and neck cutaneous melanoma. Laryngoscope Investig Otolaryngol 2020; 6:109-115. [PMID: 33614938 PMCID: PMC7883603 DOI: 10.1002/lio2.509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/17/2020] [Indexed: 12/28/2022] Open
Abstract
Importance While regression is a commonly reported microscopic feature of melanoma, its prognostic significance is unclear. Objective To examine the impact of regression on sentinel node status and the likelihood of recurrence in primary cutaneous melanoma of the head and neck. Design Retrospective analysis of 191 adults who underwent surgical management for primary cutaneous melanoma of the head and neck between May 2002 and March 2019. Setting Tertiary academic center. Participants Patients appropriate for the study were identified by the Academic Health Center Information Exchange using a list of current procedural terminology codes. One hundred and ninety‐one cases of invasive melanoma of the head and neck were included from 830 patients identified. Clinical features assessed for each patient included age, sex, location of primary lesion, date of diagnosis, and current disease status (alive with or without disease). Histologic features assessed were histological melanoma subtype (nodular vs non‐nodular), Breslow thickness, Clark level, presence/absence of ulceration, mitotic rate per square millimeter, and regression. If applicable, sentinel lymph node biopsy (SLNB) status, date of recurrence, interval treatments, and date of death related to melanoma were recorded. Exclusion criteria included melanoma outside the anatomic parameters of head and neck, ocular or choroidal melanoma, mucosal melanoma, metastatic melanoma to the head or neck with no known primary tumor, melanoma of the head or neck with no surgical intervention, and non‐melanoma skin cancers of the head and neck. Intervention/Exposure Surgery for cutaneous melanoma of the head and neck. Main Outcome(s) and Measure(s) The association between presence of regression and Breslow thickness, sentinel node status, and recurrence. Results Of the 191 patients identified, 30.9% were female and 69.1% were male with a mean age at diagnosis of 62.6 (range 20‐97) years. Mean Breslow thickness was 1.2 mm in those with regression and 2.0 mm in those without regression. In patients with regression, 17.6% had a positive sentinel node, and 13.0% experienced a recurrence. In patients without regression, 26.5% had a positive sentinel node, and 31.4% experienced a recurrence. When adjusted for other factors above, regression was not associated with positive sentinel node (odds ratio [OR] = 0.59, 95% confidence interval [CI] = 0.13‐2.00) or recurrence (OR = 0.33, CI = 0.07‐1.01). Mitotic rate >2 was associated with recurrence (OR = 2.71, CI = 1.11‐6.75, P = .03). Conclusions and Relevance Patients with presence of regression had thinner melanomas and trended toward decreased rates of sentinel node positivity and recurrence, suggesting regression may not be a negative prognostic indicator in patients with cutaneous melanoma of the head and neck.
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Affiliation(s)
- Elizabeth Kim
- Department of Otolaryngology-Head and Neck Surgery University of Minnesota Minneapolis Minnesota USA
| | - Isaac Obermeyer
- Department of Otolaryngology-Head and Neck Surgery University of Minnesota Minneapolis Minnesota USA
| | - Nathan Rubin
- Biostatistics Core, Masonic Cancer Center University of Minnesota Minneapolis Minnesota USA
| | - Samir S Khariwala
- Department of Otolaryngology-Head and Neck Surgery University of Minnesota Minneapolis Minnesota USA
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22
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Ramirez-Moreno E, Lozano-Lozano M, O'Valle Ravassa F, Ramirez-Tortosa C, Ruiz-Villaverde R. Expression of IMP3 in a retrospective cohort of melanomas with selective lymph node biopsy. Dermatol Ther 2020; 33:e14413. [PMID: 33073451 DOI: 10.1111/dth.14413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/24/2020] [Accepted: 10/07/2020] [Indexed: 12/23/2022]
Abstract
Insulin-like growth factor-II mRNA-binding protein 3 (IMP-3), which is a member of the insulin-like growth factor mRNA-binding protein family, is expressed at high levels in many types of cancer, where it plays an important role in cell proliferation, as well as in the processes of invasion, migration, and metastasis. Its expression has also been demonstrated in malignant melanoma, but not in other benign skin lesions, which has raised the possibility of using it as a predictive and prognosis marker. Its relationship with sentinel lymph node biopsy, however, has not been explored yet. A retrospective study including 120 histological samples of patients diagnosed with malignant cutaneous melanoma in Granada, between 2012 and 2018, was developed. All patients had had a sentinel lymph node biopsy (SLNB) performed at Hospital Universitario San Cecilio. IMP3 immunostaining was simultaneously carried out in the cutaneous lesion. We observed a significant difference regarding the percentage of cells expressing IMP3 (29.73 ± 3.81 for negative SLNB vs 44.86 ± 5.91 for positive SLNB, P = .020). Our endpoint calculated according to the ROC curve of 35% was significant with P = .007. H (P = .013) and AR (P = .016) indexes, created by the percentage of positive tumor cells and the intensity of the IMP3 expression, were also statistically significant. The most optimal cut-off points to predict the positivity of the SLNB were 35 for the percentage of positive tumor cells and 70 for the H score. We found a significant association between the expression of IMP3 and the regional nodal status defined by the SLNB on malignant melanomas in our series.
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Affiliation(s)
| | - Mario Lozano-Lozano
- Department of Physical Therapy, Faculty of Health Sciences, Sport and Health Joint University Institute (iMUDS), University of Granada, Granada, Spain.,Biohealth Research Institute in Granada (ibs.GRANADA), Granada, Spain.,"Cuídate" Support Unit for Oncology Patients (UAPO-Cuídate), Granada, Spain.,Instituto Biosanitario de Granada, ibs.GRANADA, Granada, Spain
| | - Francisco O'Valle Ravassa
- Instituto Biosanitario de Granada, ibs.GRANADA, Granada, Spain.,Department of Histology, Faculty of Medicine, University of Granada, Granada, Spain
| | - César Ramirez-Tortosa
- Department of Pathology, Hospital Universitario San Cecilio, Granada, Spain.,Instituto Biosanitario de Granada, ibs.GRANADA, Granada, Spain
| | - Ricardo Ruiz-Villaverde
- Department of Physical Therapy, Faculty of Health Sciences, Sport and Health Joint University Institute (iMUDS), University of Granada, Granada, Spain.,Biohealth Research Institute in Granada (ibs.GRANADA), Granada, Spain.,"Cuídate" Support Unit for Oncology Patients (UAPO-Cuídate), Granada, Spain.,Instituto Biosanitario de Granada, ibs.GRANADA, Granada, Spain
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23
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High Mitotic Rate Predicts Sentinel Lymph Node Involvement in Thin Melanomas. J Surg Res 2020; 256:198-205. [PMID: 32711176 DOI: 10.1016/j.jss.2020.06.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/19/2020] [Accepted: 06/16/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Indications for sentinel lymph node (SLN) biopsy in the population with thin melanoma have frequently changed over time. The objective of our study was to evaluate T1 melanoma pathologic features predictive of SLN positivity with a primary focus on identifying a specific mitotic value that is most predictive of lymph node disease. Further detailed predictive features would help physicians select patients with thin melanoma for SLN biopsy. METHODS The Surveillance, Epidemiology, and End Results database was queried for all patients diagnosed with trunk or extremity cutaneous melanoma with ≤1 mm depth who underwent SLN biopsy between the years of 2010 and 2013. Patient demographics and tumor characteristics including depth, mitotic rate (MR), ulceration, and tumor location were evaluated. MR was dichotomized at multiple cut points to identify the ideal number of mitosis for MR as a predictor of SLN status. Multivariable logistic regression analyses were performed to identify the factors affecting nodal positivity and the impact of MR threshold. Kaplan-Meir curves were used for overall survival (OS) analysis. RESULTS Factors significantly associated with SLN positivity in the entire cohort included MR (P < 0.001, OR 1.24, 95% CI 1.18-1.31), tumor location (P = 0.017, OR 1.48, 95% CI 1.07-2.05), and ulceration (P < 0.001, OR 2.01, 95% CI 1.39-2.93,). An MR ≥ 4 was significant for SLN positivity (P = 0.049, OR 1.08, 95% CI 1.01-1.38). Mean OS was 46.7 mo for MR < 4 compared with 43.2 mo for MR ≥ 4 (P < 0.001). CONCLUSIONS MR ≥ 4 was significant and associated with SLN positivity in thin melanomas and asulceration. Thus, MR ≥ 4 should be considered as an indication for SLN biopsy in thin melanoma.
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24
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Song Y, Azari FS, Tang R, Shannon AB, Miura JT, Fraker DL, Karakousis GC. Patterns of Metastasis in Merkel Cell Carcinoma. Ann Surg Oncol 2020; 28:519-529. [PMID: 32405979 PMCID: PMC7220648 DOI: 10.1245/s10434-020-08587-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Indexed: 12/29/2022]
Abstract
Background Merkel cell carcinoma (MCC) is a cutaneous neuroendocrine malignancy with a propensity for regional and distant spread. Because of the relative infrequency of this disease, the patterns of metastasis in MCC are understudied. Methods Patients with American Joint Committee on Cancer (8th edition) stage I–IV MCC treated at our institution were identified (1/1/2008–2/28/2018). The first site of metastasis was classified as regional [regional lymph node (LN) basin, in-transit] or distant. Distant metastasis-free (DMFS) and MCC-specific (MSS) survival were estimated. Results Of 133 patients, 64 (48%) had stage I, 13 (10%) stage II, 48 (36%) stage III, and 8 (6%) stage IV disease at presentation. The median follow-up time in patients who remained alive was 36 (interquartile range 20–66) months. Regional or distant metastases developed in 78 (59%) patients. The first site was regional in 87%, including 73% with isolated LN involvement, and distant in 13%. Thirty-seven (28%) patients eventually developed distant disease, which most commonly involved the abdominal viscera (51%) and distant LNs (46%) first. The lung (0%) and brain (3%) were rarely the first distant sites. Stage III MCC at presentation was significantly associated with worse DMFS (hazard ratio 4.87, P = 0.001) and stage IV disease with worse MSS (hazard ratio 6.30, P = 0.002). Conclusions Regional LN metastasis is the most common first metastatic event in MCC, confirming the importance of nodal evaluation. Distant disease spread appears to have a predilection for certain sites. Understanding these patterns could help to guide surveillance strategies.
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Affiliation(s)
- Yun Song
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Feredun S Azari
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Rebecca Tang
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Adrienne B Shannon
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - John T Miura
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Douglas L Fraker
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Giorgos C Karakousis
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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25
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Bellomo D, Arias-Mejias SM, Ramana C, Heim JB, Quattrocchi E, Sominidi-Damodaran S, Bridges AG, Lehman JS, Hieken TJ, Jakub JW, Pittelkow MR, DiCaudo DJ, Pockaj BA, Sluzevich JC, Cappel MA, Bagaria SP, Perniciaro C, Tjien-Fooh FJ, van Vliet MH, Dwarkasing J, Meves A. Model Combining Tumor Molecular and Clinicopathologic Risk Factors Predicts Sentinel Lymph Node Metastasis in Primary Cutaneous Melanoma. JCO Precis Oncol 2020; 4:319-334. [PMID: 32405608 PMCID: PMC7220172 DOI: 10.1200/po.19.00206] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2020] [Indexed: 01/01/2023] Open
Abstract
PURPOSE More than 80% of patients who undergo sentinel lymph node (SLN) biopsy have no nodal metastasis. Here we describe a model that combines clinicopathologic and molecular variables to identify patients with thin and intermediate thickness melanomas who may forgo the SLN biopsy procedure due to their low risk of nodal metastasis. PATIENTS AND METHODS Genes with functional roles in melanoma metastasis were discovered by analysis of next generation sequencing data and case control studies. We then used PCR to quantify gene expression in diagnostic biopsy tissue across a prospectively designed archival cohort of 754 consecutive thin and intermediate thickness primary cutaneous melanomas. Outcome of interest was SLN biopsy metastasis within 90 days of melanoma diagnosis. A penalized maximum likelihood estimation algorithm was used to train logistic regression models in a repeated cross validation scheme to predict the presence of SLN metastasis from molecular, clinical and histologic variables. RESULTS Expression of genes with roles in epithelial-to-mesenchymal transition (glia derived nexin, growth differentiation factor 15, integrin β3, interleukin 8, lysyl oxidase homolog 4, TGFβ receptor type 1 and tissue-type plasminogen activator) and melanosome function (melanoma antigen recognized by T cells 1) were associated with SLN metastasis. The predictive ability of a model that only considered clinicopathologic or gene expression variables was outperformed by a model which included molecular variables in combination with the clinicopathologic predictors Breslow thickness and patient age; AUC, 0.82; 95% CI, 0.78-0.86; SLN biopsy reduction rate of 42% at a negative predictive value of 96%. CONCLUSION A combined model including clinicopathologic and gene expression variables improved the identification of melanoma patients who may forgo the SLN biopsy procedure due to their low risk of nodal metastasis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mark A. Cappel
- Mayo Clinic, Jacksonville, FL
- Gulf Coast Dermatopathology Laboratory, Tampa, FL
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Fortes C, Mastroeni S, Caggiati A, Passarelli F, Ricci F, Michelozzi P. High level of TILs is an independent predictor of negative sentinel lymph node in women but not in men. Arch Dermatol Res 2020; 313:57-61. [PMID: 32266533 DOI: 10.1007/s00403-020-02067-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/28/2020] [Accepted: 03/28/2020] [Indexed: 12/31/2022]
Abstract
Factors that are most associated with positive lymph node status in melanoma are Breslow thickness and ulceration. However, there are other factors that have been little explored and could help in the identification of "at risk patients" harbouring occult metastasis. The objective of this study was to determine whether intensity of tumour-infiltrating lymphocytes (TILs) in a cohort study (N = 4133) is an independent predictor of sentinel lymph node (SLN) status in patients with primary cutaneous melanoma. Of the patients with cutaneous melanoma who resulted negative for nodal metastasis, 50.7% had moderate/marked TILs versus 27.7% among those patients who resulted positive for nodal metastasis. In the multivariate analysis, controlling for sex, age, mitotic rate, ulceration and Breslow, high levels of TILs in primary invasive melanoma was associated with a lower risk of developing SLN metastasis (OR 0.46; 95% CI 0.23-0.95, p = 0.037). When the analysis was stratified by sex, the protective effect of moderate/marked TIL remained only for women (OR 0.30; 95% CI 0.10-0.93, p = 0.037) but not for men (OR 0.51; 95% CI 0.19-1.34, p = 0.172). Other independent predictors of negative lymph node were low Breslow thickness (≤ 2.0 mm) and low mitotic rate. Besides predicting a negative lymph node response, TILs were also associated with a decreased risk of 10-year mortality among females with positive lymph node. Our findings suggest that high level of TILs is an independent predictor of negative SLN status among women. Further research is warranted to confirm our findings.
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Affiliation(s)
- Cristina Fortes
- Epidemiology Unit, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Via Monti di Creta 104, 00167, Rome, Italy.
| | - S Mastroeni
- Epidemiology Unit, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Via Monti di Creta 104, 00167, Rome, Italy
| | - A Caggiati
- Plastic Surgery Department, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy
| | - F Passarelli
- Pathology Unit, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy
| | - F Ricci
- Melanoma Unit, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy
| | - P Michelozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
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27
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de Beer FSA, van Diest PJ, Sigurdsson V, El Sharouni M. Intra-nodal nevi in sentinel node-negative patients with cutaneous melanoma does not influence survival. J Eur Acad Dermatol Venereol 2019; 33:2291-2295. [PMID: 31318994 PMCID: PMC6899805 DOI: 10.1111/jdv.15814] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/08/2019] [Indexed: 12/02/2022]
Abstract
Background Melanoma patients with intra‐nodal nevi (INN) and without melanoma metastasis in the sentinel lymph node biopsy (SLNB) are generally treated as patients with negative SLNB. However, diagnosis of INN may be difficult and nodal melanoma metastases may falsely be regarded as INN. Objectives Our aim was to evaluate the clinical significance of INN in the SLNB in patients with primary cutaneous melanoma on a nationwide level in The Netherlands by comparing survival between three groups: patients with INN and without nodal melanoma metastasis (INN group), patients without INN and without nodal melanoma metastasis (negative SLNB group) and patients with nodal melanoma metastasis irrespective of INN (positive SLNB group). Methods Data were obtained from ‘PALGA’, the Dutch Nationwide Network and Registry of Histopathology and Cytopathology, yielding a cohort of adults with histologically proven, primary, invasive cutaneous melanoma patients in The Netherlands diagnosed between 2000 and 2014 who underwent SLNB. Clinical and pathological variables were extracted from the pathology text files. Differences between patients with INN, negative SLNB and positive SLNB were analysed using Kaplan–Meier analysis. Results A total of 11 274 patients were eligible for inclusion. The prevalence of INN in the SLNB was 5.0%. Melanomas with INN had similar median Breslow thickness compared to melanomas with negative SLNB and were more frequently located on trunk and upper limbs and observed in younger patients compared to melanomas with negative and positive SLNB. Overall survival of patients with INN showed no significant difference compared with negative SLNB (median follow‐up of 5.7 years of all patients). Conclusions As there seems to be no difference in overall survival between patients with INN and negative SLNB, the diagnosis of INN seems to be reliable. Current practice to treat patients with INN as patients with negative SLNB appears to be appropriate.
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Affiliation(s)
- F S A de Beer
- Department of Allergology and Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - P J van Diest
- Department of Pathology, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands
| | - V Sigurdsson
- Department of Allergology and Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M El Sharouni
- Department of Allergology and Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands
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Friedman C, Lyon M, Torphy RJ, Thieu D, Hosokawa P, Gonzalez R, Lewis KD, Medina TM, Rioth MJ, Robinson WA, Kounalakis N, McCarter MD, Gleisner AL. A nomogram to predict node positivity in patients with thin melanomas helps inform shared patient decision making. J Surg Oncol 2019; 120:1276-1283. [PMID: 31602665 DOI: 10.1002/jso.25720] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/19/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To develop a nomogram to estimate the probability of positive sentinel lymph node (+SLN) for patients with thin melanoma and to characterize its potential impact on sentinel lymph node biopsy (SLNB) rates. METHODS Patients diagnosed with thin (0.5-1.0 mm) melanoma were identified from the National Cancer Database 2012 to 2015. A multivariable logistic regression model was used to examine factors associated with +SLN, and a nomogram to predict +SLN was constructed. Nomogram performance was evaluated and diagnostic test statistics were calculated. RESULTS Of the 21 971 patients included 10 108 (46.0%) underwent SLNB, with a 4.0% +SLN rate. On multivariable analysis, age, Breslow thickness, lymphovascular invasion, ulceration, and Clark level were significantly associated with SLN status. The area under the receiver operating curve was 0.67 (95% confidence interval, 0.65-0.70). While 15 249 (69.4%) patients had either T1b tumors or T1a tumors with at least one adverse feature, only 2846 (13.0%) had a nomogram predicted probability of a +SLN ≥5%. Using this cut-off, the indication for a SLNB in these patients would be reduced by 81.3% as compared to the American Joint Committee on Cancer 8th edition staging criteria. CONCLUSIONS The risk predictions obtained from the nomogram allow for more accurate selection of patients who could benefit from SLNB.
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Affiliation(s)
- Chloe Friedman
- Department of Surgery, University of Colorado, Aurora, Colorado
| | - Madison Lyon
- Department of Surgery, University of Colorado, Aurora, Colorado
| | - Robert J Torphy
- Department of Surgery, University of Colorado, Aurora, Colorado
| | - Daniel Thieu
- Department of Surgery, University of Colorado, Aurora, Colorado
| | - Patrick Hosokawa
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado
| | - Rene Gonzalez
- Department of Medicine, University of Colorado, Aurora, Colorado
| | - Karl D Lewis
- Department of Medicine, University of Colorado, Aurora, Colorado
| | - Theresa M Medina
- Department of Medicine, University of Colorado, Aurora, Colorado
| | - Matthew J Rioth
- Department of Medicine, University of Colorado, Aurora, Colorado
| | | | | | | | - Ana L Gleisner
- Department of Surgery, University of Colorado, Aurora, Colorado
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Knackstedt R, Couto RA, Ko J, Cakmakoglu C, Wu D, Gastman B. Indocyanine Green Fluorescence Imaging with Lymphoscintigraphy for Sentinel Node Biopsy in Melanoma: Increasing the Sentinel Lymph Node-Positive Rate. Ann Surg Oncol 2019; 26:3550-3560. [PMID: 31313036 DOI: 10.1245/s10434-019-07617-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Indexed: 12/17/2023]
Abstract
INTRODUCTION The goal of this study was to analyze patients who underwent a sentinel lymph node biopsy (SLNB) in melanoma with the combination of radioisotope lymphoscintigraphy and indocyanine green (ICG) fluorescence imaging to compare our true positive (TP) rate, a means to perform immediate analysis of the SLNB, with that of the literature. METHODS Consecutive cutaneous melanoma patients who underwent SLNB with lymphoscintigraphy and ICG-based fluorescence imaging by the senior author (BG) from 2012 to 2018 were prospectively enrolled. The average expected SLN-positive rate per T stage was calculated based on three studies and compared with our SLN-positive rate. RESULTS Overall, 574 consecutive patients were analyzed. Average Breslow thickness was 1.9 mm. A total of 1754 sentinel nodes were sampled; 1497 were identified by gamma probe signaling and ICG, 241 were identified by gamma probe signaling only, and 16 were identified by ICG only. There were 123 (21.4%) patients with at least one positive SLN; 113 (91.9%) had at least one positive node identified with both gamma probe signaling and ICG, 8 (6.5%) had positive node(s) identified with gamma probe signaling only, and 2 (1.6%) had positive node(s) identified with ICG only. There was an overall 21.4% SLN-positive rate, with 8% T1, 18.5% T2, 41.1% T3, and 52.4% T4, which is higher than the predicted rates for each stage. CONCLUSIONS With the largest cohort of patients reported who underwent a melanoma SLNB with lymphoscintigraphy and ICG, we demonstrated that this technique results in higher SLN-positive rates than predicted. Patients are being followed but, given the TP data, knowledge of our results may foster the use of this modality to improve staging and treatment options.
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Affiliation(s)
- Rebecca Knackstedt
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Rafael A Couto
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jennifer Ko
- Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Cagri Cakmakoglu
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Daisy Wu
- University of Toledo Medical School, Toledo, OH, USA
| | - Brian Gastman
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
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30
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Egger ME, Stevenson M, Bhutiani N, Jordan AC, Scoggins CR, Philips P, Martin RCG, McMasters KM. Age and Lymphovascular Invasion Accurately Predict Sentinel Lymph Node Metastasis in T2 Melanoma Patients. Ann Surg Oncol 2019; 26:3955-3961. [DOI: 10.1245/s10434-019-07690-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Indexed: 11/18/2022]
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Tejera‐Vaquerizo A, Ribero S, Puig S, Boada A, Paradela S, Moreno‐Ramírez D, Cañueto J, de Unamuno B, Brinca A, Descalzo‐Gallego MA, Osella‐Abate S, Cassoni P, Carrera C, Vidal‐Sicart S, Bennássar A, Rull R, Alos L, Requena C, Bolumar I, Traves V, Pla Á, Fernández‐Orland A, Jaka A, Fernández‐Figueres MT, Hilari JM, Giménez‐Xavier P, Vieira R, Botella‐Estrada R, Román‐Curto C, Ferrándiz L, Iglesias‐Pena N, Ferrándiz C, Malvehy J, Quaglino P, Nagore E. Survival analysis and sentinel lymph node status in thin cutaneous melanoma: A multicenter observational study. Cancer Med 2019; 8:4235-4244. [PMID: 31215168 PMCID: PMC6675713 DOI: 10.1002/cam4.2358] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/02/2019] [Accepted: 06/04/2019] [Indexed: 12/27/2022] Open
Abstract
Mitotic rate is no longer considered a staging criterion for thin melanoma in the 8th edition of the American Joint Committee on Cancer Staging Manual. The aim of this observational study was to identify prognostic factors for thin melanoma and predictors and prognostic significance of sentinel lymph node (SLN) involvement in a large multicenter cohort of patients with melanoma from nine tertiary care hospitals. A total of 4249 consecutive patients with thin melanoma diagnosed from January 1, 1998 to December 31, 2016 were included. The main outcomes were disease-free interval and melanoma-specific survival for the overall population and predictors of SLN metastasis (n = 1083). Associations between survival and SLN status and different clinical and pathologic variables (sex, age, tumor location, mitosis, ulceration, regression, lymphovascular invasion, histologic subtype, Clark level, and Breslow thickness) were analyzed by Cox proportional hazards regression and logistic regression. SLN status was the most important prognostic factor for melanoma-specific survival (hazard ratio, 13.8; 95% CI, 6.1-31.2; P < 0.001), followed by sex, ulceration, and Clark level for patients who underwent SLNB. A mitotic rate of >2 mitoses/mm2 was the only factor associated with a positive SLN biopsy (odds ratio, 2.9; 95% CI, 1.22-7; P = 0.01. SLN status is the most important prognostic factor in thin melanoma. A high mitotic rate is associated with metastatic SLN involvement. SLN biopsy should be discussed and recommended in patients with thin melanoma and a high mitotic rate.
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Affiliation(s)
| | - Simone Ribero
- Medical Sciences Department, Section of DermatologyUniversity of TurinTurinItaly
| | - Susana Puig
- Melanoma Unit, Dermatology Department, Hospital ClinicUniversitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades RarasBarcelonaSpain
| | - Aram Boada
- Departamento de DermatologíaHospital Universitari Germans Trial i PujolBadalonaSpain
| | - Sabela Paradela
- Departamento de DermatologíaHospital Universitario de la CoruñaLa CoruñaSpain
| | - David Moreno‐Ramírez
- Melanoma Unit, Medical‐&‐Surgical Dermatology DepartmentHospital Universitario Virgen MacarenaSevillaSpain
| | - Javier Cañueto
- Servicio de DermatologíaComplejo Asistencial Universitario de SalamancaSalamancaSpain
- Instituto de Investigación Biomédica de SalamancaComplejo Asistencial Universitario de SalamancaSalamancaSpain
| | - Blanca de Unamuno
- Departamento de DermatologíaHospital Universitario La FeValenciaSpain
| | - Ana Brinca
- Department of DermatologyUniversity Hospital of CoimbraCoimbraPortugal
| | | | - Simona Osella‐Abate
- Medical Sciences Department, Section of Surgical PathologyUniversity of TurinTurinItaly
| | - Paola Cassoni
- Medical Sciences Department, Section of Surgical PathologyUniversity of TurinTurinItaly
| | - Cristina Carrera
- Melanoma Unit, Dermatology Department, Hospital ClinicUniversitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
| | - Sergi Vidal‐Sicart
- Nuclear Medicine DepartmentHospital Clinic Barcelona, Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
| | - Antoni Bennássar
- Melanoma Unit, Dermatology Department, Hospital ClinicUniversitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
| | - Ramón Rull
- Surgery DepartmentHospital ClinicBarcelonaSpain
| | - Llucìa Alos
- Pathology Department, Hospital ClinicUniversidad de BarcelonaBarcelonaSpain
| | - Celia Requena
- Dermatology DepartmentInstituto Valenciano de OncologíaValenciaSpain
| | - Isidro Bolumar
- Surgery DepartmentInstituto Valenciano de OncologíaValenciaSpain
| | - Víctor Traves
- Pathology DepartmentInstituto Valenciano de OncologíaValenciaSpain
| | - Ángel Pla
- Otorhinolaringology DepartmentInstituto Valenciano de OncologíaValenciaSpain
| | - A. Fernández‐Orland
- Melanoma Unit, Medical‐&‐Surgical Dermatology DepartmentHospital Universitario Virgen MacarenaSevillaSpain
| | - Ane Jaka
- Departamento de DermatologíaHospital Universitari Germans Trial i PujolBadalonaSpain
| | | | - Josep M. Hilari
- Departamento de DermatologíaHospital Universitari Germans Trial i PujolBadalonaSpain
| | - Pol Giménez‐Xavier
- Melanoma Unit, Dermatology Department, Hospital ClinicUniversitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades RarasBarcelonaSpain
| | - Ricardo Vieira
- Department of DermatologyUniversity Hospital of CoimbraCoimbraPortugal
| | | | - Concepción Román‐Curto
- Servicio de DermatologíaComplejo Asistencial Universitario de SalamancaSalamancaSpain
- Instituto de Investigación Biomédica de SalamancaComplejo Asistencial Universitario de SalamancaSalamancaSpain
| | - Lara Ferrándiz
- Melanoma Unit, Medical‐&‐Surgical Dermatology DepartmentHospital Universitario Virgen MacarenaSevillaSpain
| | | | - Carlos Ferrándiz
- Departamento de DermatologíaHospital Universitari Germans Trial i PujolBadalonaSpain
| | - Josep Malvehy
- Melanoma Unit, Dermatology Department, Hospital ClinicUniversitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades RarasBarcelonaSpain
| | - Pietro Quaglino
- Medical Sciences Department, Section of DermatologyUniversity of TurinTurinItaly
| | - Eduardo Nagore
- Dermatology DepartmentInstituto Valenciano de OncologíaValenciaSpain
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Should Sentinel Lymph Node Biopsy Be Performed for All T1b Melanomas in the New 8th Edition American Joint Committee on Cancer Staging System? J Am Coll Surg 2019; 228:466-472. [DOI: 10.1016/j.jamcollsurg.2018.12.030] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 12/17/2018] [Indexed: 11/21/2022]
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