title: Breslow thickness, clark index and ulceration are associated with sentinel lymph node metastasis in melanoma patients: a cohort analysis of 612 patients.
abstract: BACKGROUND
  Sentinel lymph node biopsy (SLNB) is the most sensitive procedure for assessing nodal status in patients with primary melanoma.
  
  
  OBJECTIVE
  To evaluate the predictive ability of usual primary melanoma prognosis factors of detecting sentinel lymph node (SLN) metastasis in patients with melanoma.
  
  
  METHODS
  A cohort of 612 consecutive patients presenting with primary skin melanoma who underwent a SLNB was evaluated. Assessment of the determinants of SLN metastasis was based on general linear model analysis. The model performance was studied using the concordance statistic and the net reclassification index. The calibration was estimated using the Hosmer-Lemeshow test.
  
  
  RESULTS
  The discrimination ability did not differ significantly between Breslow thickness (0.57), Clark index (0.61), ulceration (0.57) and histological subtype (0.55). Clark index, ulceration and Breslow thickness were all significant and independent determinants of SLN metastasis. The predictive ability of the final model was 0.657.
  
  
  CONCLUSIONS
  Breslow thickness, Clark index and ulceration are independent predictors of a SLN metastasis.
authors.affiliation: Dermatology Department, Paul Sabatier-Toulouse III University and Larrey Hospital, Toulouse, France.
authors.forename: Coline
authors.initials: C
authors.lastname: Munsch
authors.forename: Valérie
authors.initials: V
authors.lastname: Lauwers-Cances
authors.forename: Laurence
authors.initials: L
authors.lastname: Lamant
authors.forename: Catherine
authors.initials: C
authors.lastname: Gentil
authors.forename: Philippe
authors.initials: P
authors.lastname: Rochaix
authors.forename: Ignacio
authors.initials: I
authors.lastname: Garrido
authors.forename: Raphael
authors.initials: R
authors.lastname: Lopez
authors.forename: Christine
authors.initials: C
authors.lastname: Chevreau
authors.forename: Carle
authors.initials: C
authors.lastname: Paul
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meyer
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016001:Confidence Intervals; D018572:Disease-Free Survival; D005260:Female; D005602:France; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology* / Q000556:secondary*; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D012044:Regression Analysis; D018570:Risk Assessment; D021701:Sentinel Lymph Node Biopsy / Q000706:statistics & numerical data*; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology*; D012883:Skin Ulcer / Q000473:pathology*; D016019:Survival Analysis