title: The amount of metastatic melanoma in a sentinel lymph node: does it have prognostic significance?
abstract: BACKGROUND
  The amount of metastatic disease in the sentinel lymph node (SLN) is examined as a prognostic factor in malignant melanoma.
  
  
  METHODS
  SLN mapping was performed on 592 patients with stage I and II malignant melanoma from March 1, 1994, through December 31, 1999. One hundred four patients were found to have 134 sentinel SLNs containing metastatic melanoma. The slides were reviewed, and the size of the metastatic melanoma in each SLN was measured. The size of the metastatic deposit was defined as macrometastasis (>2 mm), micrometastasis (< or =2 mm), a cluster of cells (10-30 grouped cells) in the subcapsular space or interfollicular zone, or isolated melanoma cells (1 to > or =20 individual cells) in subcapsular sinuses.
  
  
  RESULTS
  The number of metastases in each SLN was isolated melanoma cells, n = 5 (3.7%); cluster of cells, n = 35 (26.1%); < or =2 mm, n = 45 (33.6%); and >2 mm, n = 49 (36.7%). Seventy-nine patients (76%) had a single positive SLN. The size of the largest nodal metastasis was used to stratify patients with multiple positive SLNs. The overall 3-year survival for patients with SLN micrometastases was 90%, versus 58% for patients with SLN macrometastases (P =.004).
  
  
  CONCLUSIONS
  The amount of metastatic melanoma in an SLN is an independent predictor of survival. Patients with SLN metastatic deposits >2 mm in diameter have significantly decreased survival.
authors.affiliation: Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA. grant_carlson@emory.org
authors.forename: Grant W
authors.initials: GW
authors.lastname: Carlson
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Murray
authors.forename: Robert H
authors.initials: RH
authors.lastname: Lyles
authors.forename: Charles A
authors.initials: CA
authors.lastname: Staley
authors.forename: Andrea
authors.initials: A
authors.lastname: Hestley
authors.forename: Cynthia
authors.initials: C
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology*