title: A retrospective, multicenter analysis of the predictive value of mitotic rate for sentinel lymph node (SLN) positivity in thin melanomas.
abstract: BACKGROUND
  There is a paucity of studies to substantiate whether the presence of a single mitosis justifies sentinel lymph node (SLN) biopsy (SLNB) in thin melanomas.
  
  
  OBJECTIVE
  We sought to determine if mitotic rate is associated with SLNB outcome when taking into account other prognostic factors.
  
  
  METHODS
  All cases of melanoma that underwent SLNB in the province of Alberta, Canada, between 2007 and 2013 were reviewed through a provincial tumor database.
  
  
  RESULTS
  A total of 1072 patients fulfilled inclusion criteria. When analyzing all melanomas regardless of thickness, mitotic rate was a good predictor of SLN status. When stratified by Breslow thickness, only intermediate melanomas (1.01-2.0 mm) demonstrated a significant relationship between mitotic rate and positive SLN status (P = .010). For melanomas 1 mm or smaller, mitotic rate was not associated with SLN status. A statistically significant interaction was identified between Breslow thickness and mitotic rate such that for decreasing Breslow depth, the effect of mitotic rate on SLNB status diminished (P = .028).
  
  
  CONCLUSIONS
  The study was retrospective in nature. There is underlying variability in mitotic rate reporting methods over time, and between different dermatopathologists.
  
  
  CONCLUSIONS
  Mitotic rate does not have unequivocal utility in predicting SLNB status in thin melanomas. There is a significant interaction between mitotic rate and Breslow depth, such that the predictive value of mitotic rate on SLN positivity may be dependent on Breslow thickness.
authors.affiliation: Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Heidi
authors.initials: H
authors.lastname: Wat
authors.affiliation: Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Ambikaipakan
authors.initials: A
authors.lastname: Senthilselvan
authors.affiliation: Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. Electronic address: tsalopek@ualberta.ca.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Salopek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002170:Canada; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016015:Logistic Models; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D008940:Mitotic Index; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate; D055815:Young Adult
keywords: breslow thickness; cutaneous neoplasm; lymphadenectomy; melanoma; mitotic figure; mitotic index; mitotic rate; prognosis; sentinel lymph node biopsy; sentinel node; staging; thin melanoma; tumors