title: Factors predictive of nonsentinel lymph node involvement and clinical outcome in melanoma patients with metastatic sentinel lymph node.
abstract: BACKGROUND
  Identification of melanoma patients who need completion lymphadenectomy and adjuvant treatment after positive sentinel lymph node (SLN) biopsy would be a fundamental step forward toward personalized medicine. This study tested the hypothesis that the microscopic features of metastatic SLNs might predict not only nonsentinel lymph node (NSLN) status, but also patients' clinical outcomes.
  
  
  METHODS
  A retrospective analysis was performed on 96 consecutive melanoma patients who underwent completion lymphadenectomy after positive SLN biopsy. Patients' age and sex, primary tumor Breslow thickness, number of positive SLNs, the largest diameter and depth of invasion of metastatic deposits in the SLN, S stage, and pattern of nodal involvement were correlated with the presence of metastatic disease in NSLNs as well as with the likelihood of tumor recurrence and patient death.
  
  
  RESULTS
  At pathological examination, 20 patients (20.8%) had metastatic melanoma in the NSLN. Pattern of nodal involvement, depth of invasion of SLN by metastatic disease, and S stage were statistically significantly associated with the presence of metastatic disease in NSLN. Multivariate analysis revealed that only the SLN depth of invasion was an independent predictor of NSLN status (P = .0035). This parameter was also significantly associated with disease-free and overall survival, both by univariate (P < .0001 and P = .0006, respectively) and multivariate (P < .0001 and P = .0013, respectively) survival analysis.
  
  
  CONCLUSIONS
  These findings support further investigation of SLN depth of invasion as a predictive factor of potential clinical use to select patients as candidates for completion lymphadenectomy and adjuvant treatment.
authors.affiliation: Department of Oncological and Surgical Sciences, Surgery Branch, University of Padova, via Giustiniani 2, 35128, Padova, Italy. carlor.rossi@unipd.it
authors.forename: Carlo Riccardo
authors.initials: CR
authors.lastname: Rossi
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: De Salvo
authors.forename: Elena
authors.initials: E
authors.lastname: Bonandini
authors.forename: Simone
authors.initials: S
authors.lastname: Mocellin
authors.forename: Mirto
authors.initials: M
authors.lastname: Foletto
authors.forename: Sandro
authors.initials: S
authors.lastname: Pasquali
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Pilati
authors.forename: Mario
authors.initials: M
authors.lastname: Lise
authors.forename: Donato
authors.initials: D
authors.lastname: Nitti
authors.forename: Elisa
authors.initials: E
authors.lastname: Rizzo
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Montesco
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology*