title: Prognostic Role of Multiple Lymphatic Basin Drainage in Sentinel Lymph Node-Negative Trunk Melanoma Patients: A Multicenter Study from the Italian Melanoma Intergroup.
abstract: BACKGROUND
  Multiple lymphatic basin drainage (MLBD) is frequently observed in patients with trunk melanoma undergoing sentinel lymph node (SLN) biopsy. Conflicting data regarding the prognostic association of MLBD in SLN-negative patients have been reported. This study aimed to investigate the prognostic role of MLBD in patients with negative SLN biopsy.
  
  
  METHODS
  Retrospective data from 656 melanoma patients who underwent a SLN biopsy (1991-2012) at six Italian centers were gathered in a multicenter database. MLBD was defined as lymphoscintigraphic and intraoperative identification of an SLN in more than one nodal basin. Clinical and pathologic variables were recorded and analyzed for their impact on survival.
  
  
  RESULTS
  SLN-negative patients with MLBD were at lower risk of melanoma recurrence [hazard ratio (HR) 0.73, P = 0.05) and melanoma-related death (HR 0.68, P = 0.001) independent of common staging features. Multivariable Cox analyses of disease-free interval (DFI) and disease-specific survival (DSS) showed that MLBD maintained a favorable role and ulceration an unfavorable role. Histologic regression was independently associated only with DFI. When survival was stratified according to presence of MLBD, histologic regression and Breslow thickness <2 mm were associated with improved DFI (5-year DFI: 96.9 vs. 66,1 %, respectively; HR 0.48, P < 0.001) and DSS (5-year DSS: 96.7 vs. 71.8 %, respectively; HR 0.52, P = 0.005) compared to patients without these three favorable parameters.
  
  
  CONCLUSIONS
  Patients with negative SLN biopsy results have better prognosis when two or more lymphatic basins are identified and analyzed. Further research is required to investigate the mechanisms behind this evidence.
authors.affiliation: Section of Dermatology, Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy. simone.ribero@unito.it.|Oncological Department, Dermatologic Surgery Department, Citta' della Salute e della Scienza di Torino Hospital, Turin, Italy. simone.ribero@unito.it.
authors.forename: Simone
authors.initials: S
authors.lastname: Ribero
authors.affiliation: Section of Dermatology, Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Osella-Abate
authors.affiliation: Surgical Oncology, Veneto Institute of Oncology IOV, IRCCS, Padua, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Pasquali
authors.affiliation: Surgical Oncology, Veneto Institute of Oncology IOV, IRCCS, Padua, Italy.|Department of Surgery, Oncology, and Gastroenterology, Surgery Branch, University of Padova, Padua, Italy.
authors.forename: Carlo Riccardo
authors.initials: CR
authors.lastname: Rossi
authors.affiliation: Plastic Surgery Unit, Regional Melanoma Referral Center, Santa Maria Annunziata Hospital, Tuscan Tumor Institute, Florence, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Borgognoni
authors.affiliation: Unit of Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Piazzalunga
authors.affiliation: Division of Surgical Oncology, IRCC-San Martino Hospital-National Cancer Institute of Genoa, Genoa, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Solari
authors.affiliation: Plastic Surgery Department, Santa Maria della Misericordia di Udine Hospital, Udine, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Schiavon
authors.affiliation: Plastic Surgery Unit, Regional Melanoma Referral Center, Santa Maria Annunziata Hospital, Tuscan Tumor Institute, Florence, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Brandani
authors.affiliation: Unit of Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Ansaloni
authors.affiliation: Division of Surgical Oncology, IRCC-San Martino Hospital-National Cancer Institute of Genoa, Genoa, Italy.
authors.forename: Erica
authors.initials: E
authors.lastname: Ponte
authors.affiliation: Plastic Surgery Department, Santa Maria della Misericordia di Udine Hospital, Udine, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Silan
authors.affiliation: Surgical Oncology, Veneto Institute of Oncology IOV, IRCCS, Padua, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Sommariva
authors.affiliation: Plastic Surgery Unit, Regional Melanoma Referral Center, Santa Maria Annunziata Hospital, Tuscan Tumor Institute, Florence, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bellucci
authors.affiliation: Oncological Department, Dermatologic Surgery Department, Citta' della Salute e della Scienza di Torino Hospital, Turin, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Macripò
authors.affiliation: Section of Dermatology, Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Quaglino
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D042601:Lymphatic Vessels / Q000473:pathology* / Q000601:surgery; D061305:Lymphoscintigraphy; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D000071036:Sentinel Lymph Node / Q000473:pathology* / Q000601:surgery; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate; D060726:Torso / Q000473:pathology* / Q000601:surgery; D055815:Young Adult; D000096142:Cutaneous Malignant Melanoma