title: Analysis of predictive factors for the outcome of complete lymph node dissection in melanoma patients with metastatic sentinel lymph nodes.
abstract: BACKGROUND
  Sentinel lymph node biopsy (SLNB) is a widely accepted procedure to accurately stage patients with melanoma. However, there is no consensus concerning the practical consequences of a positive SLN, since a survival benefit of a complete lymph node dissection (CLND) has not yet been demonstrated.
  
  
  OBJECTIVE
  We wondered whether we could identify a subgroup of patients with metastatic involvement of the SLN who could be excluded from the recommendation to undergo CLND.
  
  
  METHODS
  At the Department of Dermatology at the University of Munich, a total of 213 patients with metastatic SLNs (24.9%) were identified among 854 patients who had undergone SLNB between 1996 and 2007. All SLN-positive patients had been advised to have CLND. Survival analyses were performed by using the Kaplan-Meier approach.
  
  
  RESULTS
  A total of 176 (82.6%) of 213 SLN-positive patients underwent CLND. In this group, 26 patients (14.8%) showed metastatic disease in non-sentinel lymph nodes (NSLN). The 5-year overall survival (OS) was 26.1% in NSLN-positive patients and 74% in NSLN-negative patients. SLN-positive patients who refused CLND had a better prognosis than patients with CLND. Breslow tumor thickness was significantly associated with positive CLND status with higher median values in CLND-positive than CLND-negative patients (3.03 vs 2.22 mm).
  
  
  CONCLUSIONS
  The subgroup of patients with metastatic disease in CLND may have been too small to reach statistical significance for other tumor- or patient-related parameters. Mitotic indices of the primary melanomas had not been determined in this retrospective study; thus a possible correlation with lymph node status could not be tested.
  
  
  CONCLUSIONS
  Among SLN-positive patients, the presence of metastatic NSLN is a highly significant poor prognostic factor. Tumor thickness is a significant prognostic parameter for positive CLND status and might be considered in the decision to perform CLND in case of metastatic SLN.
authors.affiliation: Department of Dermatology and Allergology, Ludwig Maximilian University Munich, Munich, Germany. Christian.Kunte@med.uni-muenchen.de
authors.forename: Christian
authors.initials: C
authors.lastname: Kunte
authors.forename: Till
authors.initials: T
authors.lastname: Geimer
authors.forename: Jens
authors.initials: J
authors.lastname: Baumert
authors.forename: Birger
authors.initials: B
authors.lastname: Konz
authors.forename: Matthias
authors.initials: M
authors.lastname: Volkenandt
authors.forename: Michael
authors.initials: M
authors.lastname: Flaig
authors.forename: Thomas
authors.initials: T
authors.lastname: Ruzicka
authors.forename: Carola
authors.initials: C
authors.lastname: Berking
authors.forename: Monika-H
authors.initials: MH
authors.lastname: Schmid-Wendtner
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000401:mortality*; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000556:secondary / Q000601:surgery; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000401:mortality*; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery