title: Clinical significance of occult metastatic melanoma in sentinel lymph nodes and other high-risk factors based on long-term follow-up.
abstract: Selective sentinel lymphadenectomy (SSL) following preoperative lymphoscintigraphy is the most significant recent advance in the management of patients with primary melanoma. This study evaluates the prognostic value of sentinel lymph node (SLN) status and other risk factors in predicting survival and recurrence in patients with primary cutaneous melanoma. From October 1993 to July 1998 a series of 412 patients with primary invasive melanoma underwent SSL at the UCSF/ Mt. Zion Melanoma Center. The outcome of 363 evaluable patients is summarized in this study. The factors related to survival and disease recurrence were analyzed by Cox proportional hazard regression models. The overall incidence of patients with positive SLNs was 18%. Over a median follow-up of 4.8 years, the overall mortality rate in patients with primary cutaneous melanoma was 18.7%, and 74 recurrences occurred (20.4%). Mortality was significantly related to SLN status [HR = 2.06; 95% Confidence interval (CI) 1.18, 3.58], angiolymphatic invasion (HR = 2.21; 95% CI 1.08, 4.55), ulceration (HR = 1.79; 95% CI 1.02, 3.15), mitotic index (HR =1.38; 95% CI 1.01, 1.90), and tumor thickness (HR = 2.20, 95% CI 1.21, 3.99). Factors significantly related to disease-free survival included SLN status (HR = 2.09; 95% CI 1.31, 3.34), tumor thickness (HR = 1.89; 95%. CI 1.20,2.98), and age (HR= 1.26 95% CI 1.08, 1.47). SLN status was the most significant factor for melanoma recurrence and death. Other important predictors include tumor thickness, ulceration, lymphatic invasion, and mitotic index.
authors.affiliation: Department of Surgery, University of California, San Francisco, Medical Center at Mount Zion and CSF Comprehensive Cancer Center, 1600 Divisadero Street, Box 1674, San Francisco, California 94143, USA. leongs@surgery.ucsf.edu
authors.forename: Stanley P L
authors.initials: SP
authors.lastname: Leong
authors.forename: Mohammed
authors.initials: M
authors.lastname: Kashani-Sabet
authors.forename: Renee A
authors.initials: RA
authors.lastname: Desmond
authors.forename: Robert P
authors.initials: RP
authors.lastname: Kim
authors.forename: Dennis H
authors.initials: DH
authors.lastname: Nguyen
authors.forename: Kensho
authors.initials: K
authors.lastname: Iwanaga
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Treseler
authors.forename: Robert E
authors.initials: RE
authors.lastname: Allen
authors.forename: Eugene T
authors.initials: ET
authors.lastname: Morita
authors.forename: Yuting
authors.initials: Y
authors.lastname: Zhang
authors.forename: Richard W
authors.initials: RW
authors.lastname: Sagebiel
authors.forename: Seng-Jaw
authors.initials: SJ
authors.lastname: Soong
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000401:mortality*; D011379:Prognosis; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate; D013997:Time Factors