title: SLN melanoma micrometastasis predictivity of nodal status: a long term retrospective study.
abstract: BACKGROUND
  Completion lymph node dissection (CLND) is the gold standard treatment for patients with a positive sentinel lymph node (SLN) biopsy. Considering the morbidity associated with CLND it is important to identify histological features of the primary tumor and/or of SLN metastasis that could help to spare from CLND a subset of patients who have a very low risk of non-SLN metastasis. The objective of this study is to identify patients with a very low risk to develop non-SLNs recurrences and to limit unnecessary CLND.
  
  
  METHODS
  A retrospective long-term study of 80 melanoma patients with positive SLN, undergone CLND, was assessed to define the risk of additional metastasis in the regional nodal basin, on the basis of intranodal distribution of metastatic cells, using the micro-morphometric analysis (Starz classification).
  
  
  RESULTS
  This study demonstrates that among the demographic and pathologic features of primary melanoma and of SLN only the Starz classification shows prognostic significance for non-SLN status (p<0.0001). This parameter was also significantly associated with disease-free survival rate (p<0.0013).
  
  
  CONCLUSIONS
  The Starz classification can help to identify, among SLN positive patients, those who can have a real benefit from CLND. From the clinical point of view this easy and reliable method could lead to a significant reduction of unnecessary CLND in association with a substantial decrease in morbidity. The study results indicate that most of S1 subgroup patients might be safely spared from completion lymphatic node dissection. Furthermore, our experience demonstrated that Starz classification of SLN is a safe predictive index for patient stratification and treatment planning.
authors.affiliation: Department of Plastic and Reconstructive Surgery, San Gallicano Dermatologic Institute, Rome, Italy. migliano@ifo.it
authors.forename: Emilia
authors.initials: E
authors.lastname: Migliano
authors.forename: Barbara
authors.initials: B
authors.lastname: Bellei
authors.forename: Flavio Andrea
authors.initials: FA
authors.lastname: Govoni
authors.forename: Giovanni
authors.initials: G
authors.lastname: Paolino
authors.forename: Caterina
authors.initials: C
authors.lastname: Catricalà
authors.forename: Stefania
authors.initials: S
authors.lastname: Bucher
authors.forename: Pietro
authors.initials: P
authors.lastname: Donati
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D061206:Neoplasm Micrometastasis; D009367:Neoplasm Staging; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D055815:Young Adult
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