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Abstract
Sentinel lymph node biopsy is a key tool in the care of many patients with melanoma. The indications for the procedure have gradually become clearer over the 3 decades since the technique was developed. For appropriately selected patients, it carries enormous significance. Although it is a minimally invasive procedure, it does carry some risk. It is also a multidisciplinary procedure, requiring knowledge and experience from several specialties including nuclear medicine, surgery, and pathology.
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Affiliation(s)
- Jessica Crystal
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, USA
| | - Mark B Faries
- The Angeles Clinic and Research Institute, Cedars-Sinai Medical Center, 11800 Wilshire Boulevard, Suite 300, Los Angeles, CA 90025, USA.
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Picado O, Ryon EL, Möller MG, Goel N, Kesmodel SB. Relevance of sentinel lymph node biopsy for thick melanoma in the era of immunotherapy. Surg Oncol 2020; 35:309-314. [PMID: 32977102 DOI: 10.1016/j.suronc.2020.08.032] [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: 12/10/2019] [Revised: 05/06/2020] [Accepted: 08/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy provides prognostic information in patients with thick melanoma but is often underutilized. We examine regional lymph node evaluation (RLNE) in patients with thick melanoma and the effect on treatment and overall survival (OS). METHODS Patients with clinical T4N0M0 melanoma were selected from the National Cancer Database (2004-2015). Binary logistic regression analysis was used to identify factors associated with RLNE and treatment. Overall survival analysis was performed. RESULTS A total of 14 286 patients with clinical T4N0M0 melanoma were identified; RLNE was performed in 70.2% of patients, and positive LNs were identified in 27.1%. RLNE was more likely in males (OR:1.44, 95%CI: 1.32-1.56, p < .001), and patients treated at academic centers (OR:1.58, 95%CI:1.46-1.71, p < .001). Immunotherapy was more commonly used in patients with RLNE (13.9% vs 3.4%, p < .001) and was associated with positive LNs (OR:2.50, 95%CI:2.19-2.86, p < .001). The 5-year OS for RLNE was 56.9% and for no RLNE was 32.7%. Independent factors associated with better OS were treatment at an academic center (HR:0.88, 95%CI:0.84-0.93, p < .001), and immunotherapy use (HR:0.86, 95%CI:0.76-0.96, p < .001). CONCLUSION The use of RLNE in patients with thick melanoma is important for prognosis and to risk stratify patients for selection of adjuvant therapies and clinical trials.
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Affiliation(s)
- Omar Picado
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Emily L Ryon
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Mecker G Möller
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Neha Goel
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Susan B Kesmodel
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
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Karakousis GC, Faries MB. Sentinel Lymph Node Biopsy for Melanoma: Buggy Whip or Roller Bearing? Ann Surg Oncol 2020; 27:2586-2588. [PMID: 32519145 DOI: 10.1245/s10434-020-08567-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Indexed: 11/18/2022]
Affiliation(s)
| | - Mark B Faries
- The Angeles Clinic and Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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L B, S S, G G, P B, C C, R G, V G, E C. Sentinel Lymph Node Status is a Main Prognostic Parameter Needful for the Correct Staging of Patients with Melanoma Thicker than 4 mm: Single-Institution Experience and Literature Meta-Analysis. J INVEST SURG 2017; 32:151-161. [PMID: 29058494 DOI: 10.1080/08941939.2017.1384871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF THE STUDY The usefulness of sentinel lymph node biopsy in thick melanomas is debated. The aim of this study was to evaluate the possible prognostic significance of sentinel lymph node biopsy in T4 melanoma patients and to verify whether this was a homogeneous group of patients with similar poor behavior. MATERIALS AND METHODS A retrospective observational study was performed. Data were extracted from the Tuscan Regional Referral Center database. The outcome of sentinel lymph node-negative and sentinel lymph node-positive T4 melanomas were compared. A systematic review of published series on this issue and a meta-analysis were performed. RESULTS Among 125 T4 melanoma patients, 53 patients (42.4%) were sentinel lymph node-positive and 72 (57.6%) patients were sentinel lymph node-negative. The 5-year and the 10-year melanoma specific survival were 81.9% and 72.3% for sentinel lymph node-negative patients and 42.4% and 17.9% (P < 0.001) for sentinel lymph node-positive patients. A positive sentinel lymph node showed an HR of 3.08. The meta-analysis confirmed that there was a significantly greater risk of death for patients with thick melanoma and positive sentinel lymph node (RR 1.75). CONCLUSIONS The results of the study point out that the sentinel lymph node biopsy is required for the correct staging of patients with melanoma thicker than 4 mm and that the status of sentinel lymph node is a significant predictor of melanoma specific survival. This knowledge allows early surgical and adjuvant treatment as well as appropriate trial enrollment and tailored follow-up.
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Affiliation(s)
- Borgognoni L
- a Unit of Plastic and Reconstructive Surgery, Regional Melanoma Referral Center and Melanoma & Skin Cancer Unit, S.M. Annunziata Hospital, AUSL Toscana Centro , Tuscan Tumor Institute (ITT) , Florence , Italy
| | - Sestini S
- a Unit of Plastic and Reconstructive Surgery, Regional Melanoma Referral Center and Melanoma & Skin Cancer Unit, S.M. Annunziata Hospital, AUSL Toscana Centro , Tuscan Tumor Institute (ITT) , Florence , Italy
| | - Gerlini G
- a Unit of Plastic and Reconstructive Surgery, Regional Melanoma Referral Center and Melanoma & Skin Cancer Unit, S.M. Annunziata Hospital, AUSL Toscana Centro , Tuscan Tumor Institute (ITT) , Florence , Italy
| | - Brandani P
- a Unit of Plastic and Reconstructive Surgery, Regional Melanoma Referral Center and Melanoma & Skin Cancer Unit, S.M. Annunziata Hospital, AUSL Toscana Centro , Tuscan Tumor Institute (ITT) , Florence , Italy
| | - Chiarugi C
- a Unit of Plastic and Reconstructive Surgery, Regional Melanoma Referral Center and Melanoma & Skin Cancer Unit, S.M. Annunziata Hospital, AUSL Toscana Centro , Tuscan Tumor Institute (ITT) , Florence , Italy
| | - Gelli R
- a Unit of Plastic and Reconstructive Surgery, Regional Melanoma Referral Center and Melanoma & Skin Cancer Unit, S.M. Annunziata Hospital, AUSL Toscana Centro , Tuscan Tumor Institute (ITT) , Florence , Italy
| | - Giannotti V
- a Unit of Plastic and Reconstructive Surgery, Regional Melanoma Referral Center and Melanoma & Skin Cancer Unit, S.M. Annunziata Hospital, AUSL Toscana Centro , Tuscan Tumor Institute (ITT) , Florence , Italy
| | - Crocetti E
- a Unit of Plastic and Reconstructive Surgery, Regional Melanoma Referral Center and Melanoma & Skin Cancer Unit, S.M. Annunziata Hospital, AUSL Toscana Centro , Tuscan Tumor Institute (ITT) , Florence , Italy
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Boada A, Tejera-Vaquerizo A, Ribero S, Puig S, Moreno-Ramírez D, Descalzo-Gallego MA, Fierro MT, Quaglino P, Carrera C, Malvehy J, Vidal-Sicart S, Bennássar A, Rull R, Alos L, Requena C, Bolumar I, Traves V, Pla Á, Fernández-Figueras MT, Ferrándiz C, Pascual I, Manzano JL, Sánchez-Lucas M, Giménez-Xavier P, Ferrandiz L, Nagore E. Sentinel lymph node biopsy versus observation in thick melanoma: A multicenter propensity score matching study. Int J Cancer 2017; 142:641-648. [DOI: 10.1002/ijc.31078] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/12/2017] [Accepted: 09/14/2017] [Indexed: 12/30/2022]
Affiliation(s)
- Aram Boada
- Dermatology Department; Hospital Universitari Germans Trial i Pujol, Badalona, Universitat Autònoma de Barcelona; Spain
| | | | - Simone Ribero
- Medical Sciences Department, Section of Dermatology; University of Turin; Italy
| | - Susana Puig
- Melanoma Unit, Dermatology Department, Hospital Clinic; Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Raras; Barcelona Spain
| | - David Moreno-Ramírez
- Melanoma Unit, Medical-&-Surgical Dermatology Department; Hospital Universitario Virgen Macarena; Sevilla Spain
| | | | - María T. Fierro
- Medical Sciences Department, Section of Dermatology; University of Turin; Italy
| | - Pietro Quaglino
- Medical Sciences Department, Section of Dermatology; University of Turin; Italy
| | - Cristina Carrera
- Melanoma Unit, Dermatology Department, Hospital Clinic; Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Raras; Barcelona Spain
| | - Josep Malvehy
- Melanoma Unit, Dermatology Department, Hospital Clinic; Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Raras; Barcelona Spain
| | - Sergi Vidal-Sicart
- Nuclear Medicine Department, Hospital Clinic Barcelona; Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - Antoni Bennássar
- Melanoma Unit, Dermatology Department, Hospital Clinic; Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - Ramón Rull
- Surgery Department; Hospital Clinic; Barcelona Spain
| | - Llucìa Alos
- Pathology Department, Hospital Clinic; Universidad de Barcelona; Barcelona Spain
| | - Celia Requena
- Dermatology Department; Instituto Valenciano de Oncología; Valencia Spain
| | - Isidro Bolumar
- Surgery Department; Instituto Valenciano de Oncología; Valencia Spain
| | - Víctor Traves
- Pathology Department; Instituto Valenciano de Oncología; Valencia Spain
| | - Ángel Pla
- Otorhinolaringology Department; Instituto Valenciano de Oncología; Valencia Spain
| | | | - Carlos Ferrándiz
- Dermatology Department; Hospital Universitari Germans Trial i Pujol, Badalona, Universitat Autònoma de Barcelona; Spain
| | - Iciar Pascual
- Surgery Department; Hospital Universitari Germans Trial i Pujol; Badalona Spain
| | - José L. Manzano
- Medical Oncology Department; Institut Català d'Oncologia, Hospital Universitari Germans Trial i Pujol; Badalona Spain
| | - Marina Sánchez-Lucas
- Grupo de Investigación, Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica, Hospital Universitario Virgen Macarena; Sevilla Spain
| | - Pol Giménez-Xavier
- Melanoma Unit, Dermatology Department, Hospital Clinic; Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Raras; Barcelona Spain
| | - Lara Ferrandiz
- Melanoma Unit, Medical-&-Surgical Dermatology Department; Hospital Universitario Virgen Macarena; Sevilla Spain
| | - Eduardo Nagore
- Dermatology Department; Instituto Valenciano de Oncología; Valencia Spain
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Breslow thickness and 18 F-FDG PET/CT results in initial staging of cutaneous melanoma: Can a cut-off point be established? Rev Esp Med Nucl Imagen Mol 2016. [DOI: 10.1016/j.remnie.2016.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Ortega-Candil A, Rodríguez-Rey C, Cano-Carrizal R, Cala-Zuluaga E, González Larriba JL, Jiménez-Ballvé A, Fuentes-Ferrer ME, Cabrera-Martín MN, Pérez-Castejón MJ, García García-Esquinas M, Lapeña-Gutierrez L, Carreras-Delgado JL. Breslow thickness and (18)F-FDG PET-CT result in initial staging of cutaneous melanoma: Can a cut-off point be established? Rev Esp Med Nucl Imagen Mol 2015; 35:96-101. [PMID: 26597332 DOI: 10.1016/j.remn.2015.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/18/2015] [Accepted: 09/21/2015] [Indexed: 10/22/2022]
Abstract
AIM To establish a Breslow Thickness (BT) cut-off point for indication of PET-CT of cutaneous melanoma in early stages and evaluate its prognostic value. MATERIAL AND METHODS Retrospective analysis of 347 PET-CT studies with diagnosis of melanoma, of which 108 were performed for initial staging. Thirty-one patients were excluded, and a final sample of 77 patients remained. A ROC curve analysis was performed to establish an optimal cut-off point. A survival analysis was performed, considering death assignable to melanoma as the main event, for the evaluation of its prognostic value. RESULTS Forty-seven (61.04%) of all 77 patients selected were men, and 11 (14.29%) had a positive PET-CT result. Mean age was 65.17±15.00 years. The median BT in patients with a negative PET-CT result was 2.75 mm (IQR 1.83-4.50) and in the positive group 6.25 mm (IQR 5.40-7.50) (P=.0013). In the ROC curve analysis (AUC 0.804, SE 0.054), an optimal value of 5 mm BT with the following values was obtained: sensitivity 90.91%, specificity 78.79%, negative predictive value (NPV) 98.1%, positive predictive value (PPV) 41.7%, diagnostic OR 37.1, and accuracy 80.52%. Mean follow-up was 18.66±14,35 months, detecting 2/53 (3.77%) deaths in the BT<5 mm group, and 7/24 (29.17%) in the BT≥5 mm group. Survival curves between both groups were significantly different (P=.0013). CONCLUSIONS A 5 mm cut-off point correctly distinguishes those patients with positive PET-CT from those with negative results in the early stages of cutaneous melanoma; therefore it could be included in initial staging of this subgroup of patients.
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Affiliation(s)
- A Ortega-Candil
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España.
| | - C Rodríguez-Rey
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - R Cano-Carrizal
- Servicio de Cardiología, Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - E Cala-Zuluaga
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - J L González Larriba
- Servicio de Oncología Médica, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - A Jiménez-Ballvé
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - M E Fuentes-Ferrer
- Unidad de Gestión Clínica de Medicina Preventiva, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - M N Cabrera-Martín
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - M J Pérez-Castejón
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - M García García-Esquinas
- Servicio de Radiodiagnóstico, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - L Lapeña-Gutierrez
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - J L Carreras-Delgado
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
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Kachare SD, Singla P, Vohra NA, Zervos EE, Wong JH, Fitzgerald TL. Sentinel lymph node biopsy is prognostic but not therapeutic for thick melanoma. Surgery 2015; 158:662-8. [DOI: 10.1016/j.surg.2015.05.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 05/15/2015] [Accepted: 05/21/2015] [Indexed: 01/22/2023]
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Otsuka M, Yamasaki O, Kaji T, Iwatsuki K, Asagoe K. Sentinel lymph node biopsy for 102 patients with primary cutaneous melanoma at a single Japanese institute. J Dermatol 2015; 42:954-61. [DOI: 10.1111/1346-8138.12972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 04/29/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Masaki Otsuka
- Department of Dermatology; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; Okayama Japan
| | - Osamu Yamasaki
- Department of Dermatology; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; Okayama Japan
| | - Tatsuya Kaji
- Department of Dermatology; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; Okayama Japan
| | - Keiji Iwatsuki
- Department of Dermatology; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; Okayama Japan
| | - Kenji Asagoe
- Department of Dermatology; National Hospital Organization Okayama Medical Center; Okayama Japan
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Monroe MM, Pattisapu P, Myers JN, Kupferman ME. Sentinel Lymph Node Biopsy Provides Prognostic Value in Thick Head and Neck Melanoma. Otolaryngol Head Neck Surg 2015; 153:372-8. [DOI: 10.1177/0194599815589948] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 05/14/2015] [Indexed: 11/15/2022]
Abstract
Objectives Sentinel lymph node biopsy (SLNB) is standard practice for intermediate-thickness head and neck melanoma (HNM) but remains controversial for melanomas more than 4 mm in thickness. The objectives of this study were to evaluate (1) the diagnostic accuracy and (2) the prognostic value of SLNB in patients with thick HNM. Study Design Case series with chart review. Setting Large cancer center between June 2000 and December 2012. Subjects 77 patients undergoing SLNB for T4 HNM without in-transit, regional, or distant metastatic disease at presentation. Methods Univariate and multivariate analyses of prognostic factors were performed. Results 77 patients underwent attempted SLNB for T4 HNM without in-transit, regional, or distant metastatic disease at presentation. The mean patient age was 62 years (range, 4-87 years) and there was a male predominance (80%). Mean Breslow thickness was 6.1 mm (range, 4-21 mm). Of the 77 patients undergoing attempted SLNB, 7 had no identifiable sentinel lymph node (9%). For the remaining 91% with 1 or more identifiable sentinel lymph nodes, the mean number of nodes identified was 3.3 (range, 1-13). The sentinel lymph node positivity rate was 24%. A false-negative SLNB occurred in 2 patients (3.8%). With a median follow-up of 36 months, the estimated 5-year disease-free, disease-specific, and overall survival rates were 47%, 74%, and 69%, respectively. A positive sentinel lymph node was significantly linked to shortened disease-free survival (74 vs 36 months, P = .026) and disease-specific survival (121 vs 59 months, P = .035). Conclusion SLNB provides accurate staging of the regional node basin and important prognostic information for patients with thick HNM.
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Affiliation(s)
- Marcus M. Monroe
- Division of Otolaryngology, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | | | - Jeffrey N. Myers
- Department of Head and Neck Surgery, the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael E. Kupferman
- Department of Head and Neck Surgery, the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Dwojak S, Emerick KS. Sentinel lymph node biopsy for cutaneous head and neck malignancies. Expert Rev Anticancer Ther 2014; 15:305-15. [DOI: 10.1586/14737140.2015.990441] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Ribero S, Osella-Abate S, Sanlorenzo M, Balagna E, Senetta R, Fierro MT, Macripò G, Macrì L, Sapino A, Quaglino P. Sentinel Lymph Node Biopsy in Thick-Melanoma Patients (N=350): What is Its Prognostic Role? Ann Surg Oncol 2014; 22:1967-73. [PMID: 25388059 DOI: 10.1245/s10434-014-4211-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) is currently recommended for patients with intermediate-thickness melanomas (T2-T3). Historically, T4 melanoma patients have not been considered good candidates for SLNB because of the high risk of distant progression. However, some authors suggest that T4 melanoma patients could be considered as a heterogeneous group that could benefit from SLNB. METHODS We retrospectively analyzed 350 patients with thick (>4 mm) melanomas between 1999 and 2011. Patients were stratified into three groups depending on the results of SLNB: (1) 94 SLNB-negative; (2) 84 SLNB-positive; and (3) 172 SLNB not performed (observation group). The associations of clinical-pathologic features with the result of SLNB, disease-free interval (DFI), and disease-specific survival (DSS) were analyzed. RESULTS Multivariate analyses confirmed a better prognosis for SLN-negative patients compared with patients in the observation group (DSS hazard ratio [HR] 0.62, p = 0.03; DFI HR 0.47, p < 0.001). The observation group was shown to have the same prognosis as the positive-sentinel lymph node group, when adjusted for principal confounders in the model. CONCLUSIONS We confirmed that thick-melanoma patients are a heterogeneous group with different prognosis. In our experience, SLNB allowed for an appropriate stratification of patients in different survival groups. On the basis of our results, we strongly recommend the routine execution of SLNB in cases of primary melanoma thicker than 4 mm.
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Affiliation(s)
- S Ribero
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy,
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Russo AE, Ferraù F, Antonelli G, Priolo D, McCubrey JA, Libra M. Malignant melanoma in elderly patients: biological, surgical and medical issues. Expert Rev Anticancer Ther 2014; 15:101-8. [PMID: 25248282 DOI: 10.1586/14737140.2015.961426] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Malignant melanoma is an aggressive tumor with a poor prognosis for patients with advanced disease. Over the last decades, its incidence and mortality has increased in elderly population, impacting significantly on healthcare costs, considering the increase in average age of the world population. Older age is recognized as an independent poor prognostic factor for melanoma, but the scientific community now is wondering if elderly melanoma patients have worse outcome because they are not receiving the same treatment as their younger counterparts. This article summarizes current data on elderly melanoma prevention and early detection and its subsequent management, underling the differences observed between older and younger patients. It also describes age-associated alterations in immunity and how these may impact on anti-melanoma response.
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Affiliation(s)
- Alessia E Russo
- Department of Biomedical Sciences, Section of Pathology and Oncology, Laboratory of Translational Oncology and Functional Genomics, University of Catania, 85 Androne Avenue, Catania 95124, Italy
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Clinical impact of sentinel lymph node biopsy in patients with thick (>4 mm) melanomas. Am J Surg 2014; 207:702-7; discussion 707. [DOI: 10.1016/j.amjsurg.2013.12.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 12/16/2013] [Accepted: 12/17/2013] [Indexed: 11/18/2022]
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Monroe MM, Myers JN, Kupferman ME. Undertreatment of thick head and neck melanomas: an age-based analysis. Ann Surg Oncol 2013; 20:4362-9. [PMID: 23975303 DOI: 10.1245/s10434-013-3160-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Indexed: 02/03/2023]
Abstract
PURPOSE To determine U.S. treatment patterns for pathologic staging practices in patients with thick head and neck melanomas (HNM). METHODS Patients with thick HNM without clinical evidence of in-transit, regional, or distant metastatic spread at presentation were identified from the Surveillance Epidemiology and End Results database. Treatment trends for patients were summarized, and univariate and multivariate analyses were performed to identify associations between varying practice patterns. RESULTS A total of 1,230 patients with HNM meeting the inclusion criteria were identified. Surgical staging procedures were utilized in 53.5 %, including both sentinel lymph node biopsy (37 %) and elective neck dissection (16 %). Patients undergoing a surgical staging procedure were younger (64 vs. 77 years, p < 0.001) with smaller tumors (6.3 vs. 6.6 mm, p = 0.008). The rate of occult nodal disease was 22 % in patients undergoing a surgical staging procedure. The presence of a positive regional node in this subgroup of patients was associated with a significant reduction in disease-specific (44 vs. 59 months, p < 0.001) and overall survival (40 vs. 53 months, p < 0.001) on univariate analysis. On multivariate analysis, the presence of a positive node was the most significant factor for reduced overall survival (hazard ratio 2.36, 95 % confidence interval 1.71-3.23) and disease-specific survival (hazard ratio 2.84, 95 % confidence interval 1.99-4.06). CONCLUSIONS Pathologic staging procedures provide independent prognostic information for patients with thick HNM. Despite this, current practice patterns demonstrate underutilization, particularly in elderly patients. Further work is needed to address the barriers to pathologic staging implementation in patients with thick HNM.
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Affiliation(s)
- Marcus M Monroe
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA,
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Freeman SR, Gibbs BB, Brodland DG, Zitelli JA. Prognostic Value of Sentinel Lymph Node Biopsy Compared with that of Breslow Thickness: Implications for Informed Consent in Patients with Invasive Melanoma. Dermatol Surg 2013; 39:1800-12. [DOI: 10.1111/dsu.12351] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sentinel lymph node biopsy in patients with thick primary cutaneous melanoma: patterns of use and underuse utilizing a population-based model. ISRN DERMATOLOGY 2013; 2013:315609. [PMID: 23378929 PMCID: PMC3556403 DOI: 10.1155/2013/315609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 12/20/2012] [Indexed: 11/18/2022]
Abstract
Background. Sentinel lymph node biopsy (SLNB) for thick cutaneous melanoma is supported by national guidelines. We report on factors associated with the use and underuse of SLNB for thick primary cutaneous melanoma. Methods. The Surveillance, Epidemiology, and End Results database was queried for patients who underwent surgery for thick primary cutaneous melanoma from 2004 to 2008. We used multivariate logistic regression models to predict use of SLNB. Results. Among 1,981 patients, 833 (41.8%) did not undergo SLNB. Patients with primary melanomas of the arm (OR 2.07, CI 1.56–2.75; P < 0.001), leg (OR 2.40, CI 1.70–3.40; P < 0.001), and trunk (OR 1.82, CI 1.38–2.40; P < 0.001) had an increased likelihood of receiving a SLNB, as did those with desmoplastic histology (OR 1.47, CI 1.11–1.96; P = 0.008). A decreased likelihood of receiving SLNB was noted for advancing age ≥ 60 years (age 60 to 69: OR 0.58, CI 0.33–0.99, P = 0.047; age 70 to 79: OR 0.32, CI 0.19–0.54, P < 0.001; age 80 or more: OR 0.10, CI 0.06–0.16, P < 0.001) and unknown race/ethnicity (OR 0.21, CI 0.07–0.62; P = 0.005). Conclusions. In particular, elderly patients are less likely to receive SLNB. Further research is needed to assess whether use of SLNB in this population is detrimental or beneficial.
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Gambichler T, Scholl L. Sentinel lymph node status is the strongest independent predictor for disease free and overall survival in patients with thick melanoma. J Eur Acad Dermatol Venereol 2012; 27:1454-6. [DOI: 10.1111/jdv.12087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 11/28/2012] [Indexed: 11/30/2022]
Affiliation(s)
- T. Gambichler
- Skin Cancer Center Ruhr-University; Department of Dermatology, Venereology and Allergology; Ruhr-University Bochum; Bochum Germany
| | - L. Scholl
- Skin Cancer Center Ruhr-University; Department of Dermatology, Venereology and Allergology; Ruhr-University Bochum; Bochum Germany
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Ortega Candil A, Rodríguez Rey C, Carreras Delgado JL. Malignant melanoma. ISRN DERMATOLOGY 2012; 2012:308279. [PMID: 23259071 PMCID: PMC3521489 DOI: 10.5402/2012/308279] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 11/07/2012] [Indexed: 11/23/2022]
Abstract
Nuclear medicine plays an essential role in the correct staging of patients suffering from melanoma. Both sentinel lymph node biopsy (SLNB) and positron emission tomography (PET) represent its main diagnostic tools. SLNB is the choice procedure for lymphatic regional staging of these patients, including the result of this technique in the 2002 American Joint Cancer Committee melanoma staging. SLNB sensitivity is superior than PET/CT for the detection of lymphatic micrometastases in early stages of the disease. PET/CT is mainly used in confirming clinical metastases suspected, detection of recurrences, and recurrence restaging. PET/CT has also shown superiority against conventional diagnostic methods in the detection of distant metastases, being able to detect illness even six months earlier than those methods.
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Affiliation(s)
- Aída Ortega Candil
- Department of Nuclear Medicine, Clinico San Carlos Hospital, 28040 Madrid, Spain
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Castellani E, Covarelli P, Boselli C, Cirocchi R, Rulli A, Barberini F, Caracappa D, Cini C, Desiderio J, Burini G, Noya G. Spontaneous splenic rupture in patient with metastatic melanoma treated with vemurafenib. World J Surg Oncol 2012; 10:155. [PMID: 22846499 PMCID: PMC3502264 DOI: 10.1186/1477-7819-10-155] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 06/08/2012] [Indexed: 01/20/2023] Open
Abstract
Background BRAF inhibitors such as vemurafenib are a new family of biological drugs, recently available to treat metastatic malignant melanoma. Methods We present the case of a 38-year-old man affected by metastatic melanoma who had been under treatment with vemurafenib for a few days. The patient suffered from sudden onset of abdominal pain due to intra-abdominal hemorrhage with profuse hemoperitoneum. An emergency abdominal sonography confirmed the clinical suspicion of a splenic rupture. Results The intraoperative finding was hemoperitoneum due to splenic two-step rupture and splenectomy was therefore performed. Histopathology confirmed splenic hematoma and capsule laceration, in the absence of metastasis. Conclusions This report describes the occurrence of a previously unreported adverse event in a patient with stage IV melanoma receiving vemurafenib.
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Affiliation(s)
- Elisa Castellani
- Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy
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Sentinel lymph node status as most important prognostic factor in patients with high-risk cutaneous melanomas (tumour thickness >4.00 mm): outcome analysis from a single institution. Eur J Nucl Med Mol Imaging 2012; 39:1316-25. [DOI: 10.1007/s00259-012-2139-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Accepted: 04/11/2012] [Indexed: 12/19/2022]
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