title: No non-sentinel node involvement in melanoma patients with limited Breslow thickness and low sentinel node tumour load.
abstract: OBJECTIVE
  Most melanoma patients with a positive sentinel node (SN) undergo completion lymph node dissection and frequently experience associated morbidity. However, only 10-30% of SN-positive patients have further lymph node metastases. The aim of the present study was to predict the absence of non-SN metastases in a multicentre study of patients with a positive SN based on primary melanoma features and SN tumour load.
  
  
  RESULTS
  Of 70 SN positive patients, 18 had non-SN metastases. Penetrative depth of metastatic cells into the SN and SN tumour load was assessed by morphometry. None of the 14 patients (20%) with a Breslow thickness <2.0 mm and an SN tumour load <0.2 mm2 had non-SN metastases. Similarly, none of the 15 patients (21%) with a Breslow thickness <2.0 mm and SN penetrative depth <600 μm had non-SN metastases. Lastly, none of the 14 patients (20%) with a Breslow thickness <2.0 mm and a diameter of the largest SN deposit <500 μm had non-SN metastases.
  
  
  CONCLUSIONS
  A combination of limited Breslow thickness and low SN tumour load predicts absence of non-SN metastases in melanoma patients with a positive SN with high accuracy. We propose that this subgroup may be spared completion lymph node dissection.
authors: Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Thomas
authors: T
authors: Bogenrieder
authors: Marijke R
authors: MR
authors: van Dijk
authors: Willeke A M
authors: WA
authors: Blokx
authors: Katrin
authors: K
authors: Ramrath
authors: Kees
authors: K
authors: Seldenrijk
authors: Wilhelm
authors: W
authors: Stolz
authors: Paul J
authors: PJ
authors: van Diest
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008297:Male; D008545:Melanoma / Q000556:secondary*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology*; D055815:Young Adult