title: Prognosis in patients with sentinel node-positive melanoma is accurately defined by the combined Rotterdam tumor load and Dewar topography criteria.
abstract: OBJECTIVE
  Prognosis in patients with sentinel node (SN)-positive melanoma correlates with several characteristics of the metastases in the SN such as size and site. These factors reflect biologic behavior and may separate out patients who may or may not need additional locoregional and/or systemic therapy.
  
  
  METHODS
  Between 1993 and 2008, 1,080 patients (509 women and 571 men) were diagnosed with tumor burden in the SN in nine European Organisation for Research and Treatment of Cancer (EORTC) melanoma group centers. In total, 1,009 patients (93%) underwent completion lymph node dissection (CLND). Median Breslow thickness was 3.00 mm. The median follow-up time was 37 months. Tumor load and tumor site were reclassified in all nodes by the Rotterdam criteria for size and in 88% by the Dewar criteria for topography.
  
  
  RESULTS
  Patients with submicrometastases (< 0.1 mm in diameter) were shown to have an estimated 5-year overall survival rate of 91% and a low nonsentinel node (NSN) positivity rate of 9%. This is comparable to the rate in SN-negative patients. The strongest predictive parameter for NSN positivity and prognostic parameter for survival was the Rotterdam-Dewar Combined (RDC) criteria. Patients with submicrometastases that were present in the subcapsular area only, had an NSN positivity rate of 2% and an estimated 5- and 10-year melanoma-specific survival (MSS) of 95%.
  
  
  CONCLUSIONS
  Patients with metastases < 0.1 mm, especially when present in the subcapsular area only, may be overtreated by a routine CLND and have an MSS that is indistinguishable from that of SN-negative patients. Thus the RDC criteria provide a rational basis for decision making in the absence of conclusions provided by randomized controlled trials.
authors.affiliation: Erasmus University Medical Center-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
authors.forename: Augustinus P T
authors.initials: AP
authors.lastname: van der Ploeg
authors.forename: Alexander C J
authors.initials: AC
authors.lastname: van Akkooi
authors.forename: Piotr
authors.initials: P
authors.lastname: Rutkowski
authors.forename: Zbigniew I
authors.initials: ZI
authors.lastname: Nowecki
authors.forename: Wanda
authors.initials: W
authors.lastname: Michej
authors.forename: Angana
authors.initials: A
authors.lastname: Mitra
authors.forename: Julia A
authors.initials: JA
authors.lastname: Newton-Bishop
authors.forename: Martin
authors.initials: M
authors.lastname: Cook
authors.forename: Iris M C
authors.initials: IM
authors.lastname: van der Ploeg
authors.forename: Omgo E
authors.initials: OE
authors.lastname: Nieweg
authors.forename: Mari F C M
authors.initials: MF
authors.lastname: van den Hout
authors.forename: Paul A M
authors.initials: PA
authors.lastname: van Leeuwen
authors.forename: Christiane A
authors.initials: CA
authors.lastname: Voit
authors.forename: Francesco
authors.initials: F
authors.lastname: Cataldo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Testori
authors.forename: Caroline
authors.initials: C
authors.lastname: Robert
authors.forename: Harald J
authors.initials: HJ
authors.lastname: Hoekstra
authors.forename: Cornelis
authors.initials: C
authors.lastname: Verhoef
authors.forename: Alain
authors.initials: A
authors.lastname: Spatz
authors.forename: Alexander M M
authors.initials: AM
authors.lastname: Eggermont
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology*; D055815:Young Adult