title: Dermal melanoma: A report on prognosis, outcomes, and the utility of sentinel lymph node biopsy.
abstract: BACKGROUND
  Historically dermal melanoma (DM) has been labeled as either stage IIIB (in-transit) or stage IV (M1a) disease. We sought to investigate the natural history of DM and the utility and prognostic significance of sentinel lymph node biopsy (SLNB).
  
  
  METHODS
  Patients with DM undergoing SLNB at a single center from 1998 to 2009 were identified.
  
  
  RESULTS
  Eighty-three patients met criteria, 10 (12%) patients had a positive SLNB. Of those, 5 (50%) recurred (all with distant disease). Twenty-one (29%) of the 73 SLNB negative patients recurred and of those, 15 (71%) developed distant metastases, whereas 6 (29%) developed local or regional recurrence, including two false-negative regional nodal recurrences. No in-transit recurrences were recorded. Five-year recurrence-free and disease-specific survival was significantly better for patients with a negative SLNB versus positive SLNB (56.8% vs. 22.2% P = 0.02, 81.1% vs. 61.0%, P = 0.05, respectively).
  
  
  CONCLUSIONS
  SLNB has prognostic significance for RFS and DSS, and should be utilized in the management of DM based on a >10% yield and low false-negative rate. Our data demonstrate patients with DM do not recur in an in-transit fashion, which along with the survival outcomes suggest the behavior of DM is consistent with primary cutaneous melanoma of similar thickness rather than an isolated in-transit or distant dermal metastasis from a regressed cutaneous primary.
authors.affiliation: Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Doepker
authors.affiliation: Department of Biostatistics, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Zachary J
authors.initials: ZJ
authors.lastname: Thompson
authors.affiliation: Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Harb
authors.affiliation: Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Jane L
authors.initials: JL
authors.lastname: Messina
authors.affiliation: Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Puleo
authors.affiliation: Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Egan
authors.affiliation: Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Amod A
authors.initials: AA
authors.lastname: Sarnaik
authors.affiliation: Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Gonzalez
authors.affiliation: Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Vernon K
authors.initials: VK
authors.lastname: Sondak
authors.affiliation: Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Zager
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D000096142:Cutaneous Malignant Melanoma
keywords: dermatopathologist; in-transit disease; metastases; regression