Thin Melanoma with Nodal Involvement: Analysis of Demographic, Pathologic, and Treatment Factors with Regard to Prognosis.
BACKGROUND
Although only a small proportion of thin melanomas result in lymph node metastasis, the abundance of these lesions results in a relatively large absolute number of patients with a diagnosis of nodal metastases, determined by either sentinel lymph node (SLN) biopsy or clinical nodal recurrence (CNR).


METHODS
Independent cohorts with thin melanoma and either SLN metastasis or CNR were identified at two melanoma referral centers. At both centers, SLN metastasis patients were included. At center 1, the CNR cohort included patients with initial negative clinical nodal evaluation followed by CNR. At center 2, the CNR cohort was restricted to those presenting in the era before the use of SLN biopsy. Uni- and multivariable analyses of melanoma-specific survival (MSS) were performed.


RESULTS
At center 1, 427 CNR patients were compared with 91 SLN+ patients. The 5- and 10-year survival rates in the SLN group were respectively 88 and 84 % compared with 72 and 49 % in the CNR group (p < 0.0001). The multivariate analysis showed age older than 50 years (hazard ratio [HR] 1.5; 95 % confidence interval [CI] 1.2-1.9), present ulceration (HR 1.9; 95 % CI 1.2-2.9), unknown ulceration (HR 1.6; 95 % CI 1.3-2.1), truncal site (HR 1.6; 95 % CI 1.2-2.2), and CNR (HR 3.3; 95 % CI 1.8-6.0) to be associated significantly with decreased MSS (p < 0.01 for each). The center 2 cohort demonstrated remarkably similar findings, with a 5-year MSS of 88 % in the SLN (n = 29) group and 76 % in the CNR group (n = 39, p = 0.09).


CONCLUSIONS
Patients with nodal metastases from thin melanomas have a substantial risk of melanoma death. This risk is lower among patients whose disease is discovered by SLN biopsy rather than CNR.
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. giorgos.karakousis@uphs.upenn.edu.
Giorgos
G
Karakousis
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Phyllis A
PA
Gimotty
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Edmund K
EK
Bartlett
John Wayne Cancer Institute, Santa Monica, CA, USA.
Myung-Shin
MS
Sim
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Madalyn G
MG
Neuwirth
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Douglas
D
Fraker
Moffit Cancer Center, Tampa, FL, USA.
Brian J
BJ
Czerniecki
John Wayne Cancer Institute, Santa Monica, CA, USA.
Mark B
MB
Faries
D000367:Age Factors; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000556:secondary; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D000071036:Sentinel Lymph Node / Q000473:pathology*; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology*; D012883:Skin Ulcer / Q000209:etiology; D015996:Survival Rate; D060726:Torso; D047368:Tumor Burden