title: Is completion lymph node dissection needed in case of minimal melanoma metastasis in the sentinel node?
abstract: OBJECTIVE
  The purpose of this study was to evaluate the micromorphometric Starz-classification in melanoma patients.
  
  
  BACKGROUND
  The micromorphometric Starz-classification suggests that melanoma patients with a sentinel node metastasis invading no more than 0.3 mm (S-I) or 0.31 to 1.0 mm (S-II) below the capsular level can be spared further surgery, while invasion of the metastasis of more than 1.0 mm (S-III) implies a need for completion dissection.
  
  
  METHODS
  Seventy patients with sentinel node metastases were studied. Twenty patients with an S-I or S-II classification were spared further surgery and 50 S-III patients underwent completion dissection. The median follow-up time was 33 months.
  
  
  RESULTS
  No lymph node recurrences were detected in the 20 S-I, II patients. Six of the 50 S-III patients (12%) had additional involved nodes in the dissection specimen. In these patients no recurrences developed in the cleared regional basins. Overall 3-year survival was 100% in the S-I, II patients and 80% in the S-III patients (P = 0.04). Three-year disease-free survival rates were 83% and 60%, respectively (P = 0.40).
  
  
  CONCLUSIONS
  : This study suggests that further surgery is unnecessary in S-I and S-II patients, while it does seem prudent to carry out completion dissection in S-III patients. The distinct survival difference between the 2 groups of patients suggests that the S-classification also has prognostic implications.
authors.affiliation: Departments of Surgery, the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands. i.vd.ploeg@nki.nl
authors.forename: Iris M C
authors.initials: IM
authors.lastname: van der Ploeg
authors.forename: Bin B R
authors.initials: BB
authors.lastname: Kroon
authors.forename: Ninja
authors.initials: N
authors.lastname: Antonini
authors.forename: Renato A
authors.initials: RA
authors.lastname: Valdés Olmos
authors.forename: Omgo E
authors.initials: OE
authors.lastname: Nieweg
mesh_terms: D015331:Cohort Studies; D018572:Disease-Free Survival; D006801:Humans; D008545:Melanoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome