title: Prognostic significance of tumor mitotic rate in T2 melanoma staged with sentinel lymphadenectomy.
abstract: OBJECTIVE
  Tumor mitotic rate (TMR) is an important prognostic variable for patients with thin melanoma. However it remains unclear what the significance of TMR is for more deeply invasive melanoma pathologically staged with a sentinel lymph node biopsy. We sought to determine the prognostic value of TMR in clinically node-negative T2 melanoma patients staged with sentinel lymphadenectomy.
  
  
  METHODS
  A prospective IRB-approved database of cutaneous melanoma patients treated from 09/01/1997-03/01/2011 was used to identify patients with T2 melanoma staged with a SLN. Associations were evaluated using Fisher's Exact test, and Kaplan-Meier analysis.
  
  
  RESULTS
  Three hundred thirteen T2 patients were included. 19% had ulceration, 11% a positive sentinel node (SLN), and 10% recurred. 44% of patients had TMR ≥ 1/mm(2). TMR ≥ 1/mm(2) did not predict SLN status. TMR ≥ 1/mm(2) was significantly associated with recurrence in SLN negative patients; only 3% of those with TMR < 1/mm(2) developed a recurrence compared to 16% of those with TMR ≥ 1/mm(2) (P < 0.0001).
  
  
  CONCLUSIONS
  Although TMR ≥ 1/mm(2) is not associated with risk of SLN involvement in T2 melanoma, it is a significant risk factor for recurrence when SLN negative. As such, TMR could be used to stratify follow-up regimens in SLN negative T2 patients.
authors: Department of Surgery, Maine Medical Center, Portland, Maine.
authors: Justin J
authors: JJ
authors: Baker
authors: Michael O
authors: MO
authors: Meyers
authors: Allison M
authors: AM
authors: Deal
authors: Jill F
authors: JF
authors: Frank
authors: Karyn B
authors: KB
authors: Stitzenberg
authors: David W
authors: DW
authors: Ollila
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D008938:Mitosis; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology*; D012883:Skin Ulcer / Q000473:pathology
keywords: melanoma; recurrence; sentinel lymph node; tumor mitotic rate