title: The Impact of Smoking on Sentinel Node Metastasis of Primary Cutaneous Melanoma.
abstract: BACKGROUND
  Although a well-established causative relationship exists between smoking and several epithelial cancers, the association of smoking with metastatic progression in melanoma is not well studied. We hypothesized that smokers would be at increased risk for melanoma metastasis as assessed by sentinel lymph node (SLN) biopsy.
  
  
  METHODS
  Data from the first international Multicenter Selective Lymphadenectomy Trial (MSLT-I) and the screening-phase of the second trial (MSLT-II) were analyzed to determine the association of smoking with clinicopathologic variables and SLN metastasis.
  
  
  RESULTS
  Current smoking was strongly associated with SLN metastasis (p = 0.004), even after adjusting for other predictors of metastasis. Among 4231 patients (1025 in MSLT-I and 3206 in MSLT-II), current or former smoking was also independently associated with ulceration (p < 0.001 and p < 0.001, respectively). Compared with current smoking, never smoking was independently associated with decreased Breslow thickness in multivariate analysis (p = 0.002) and with a 0.25 mm predicted decrease in thickness.
  
  
  CONCLUSIONS
  The direct correlation between current smoking and SLN metastasis of primary cutaneous melanoma was independent of its correlation with tumor thickness and ulceration. Smoking cessation should be strongly encouraged among patients with or at risk for melanoma.
authors.affiliation: Division of Surgical Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.
authors.forename: Maris S
authors.initials: MS
authors.lastname: Jones
authors.affiliation: Division of Surgical Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.|Department of Molecular Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Jones
authors.affiliation: Department of Biostatistics, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Stern
authors.affiliation: UCLA Department of Biostatistics, Los Angeles, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Elashoff
authors.affiliation: Department of Molecular Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.
authors.forename: Dave S B
authors.initials: DSB
authors.lastname: Hoon
authors.affiliation: Melanoma Institute Australia, Sydney, NSW, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Thompson
authors.affiliation: Istituto Nazionale dei Tumori Napoli, Napoli, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Mozzillo
authors.affiliation: Melanoma Institute Australia, Sydney, NSW, Australia.
authors.forename: Omgo E
authors.initials: OE
authors.lastname: Nieweg
authors.affiliation: IHC Cancer Services, Intermountain Medical Center, Salt Lake City, UT, USA.
authors.forename: Dirk
authors.initials: D
authors.lastname: Noyes
authors.affiliation: Universitair Medisch Centrum Groningen, Groningen, The Netherlands.
authors.forename: Harald J
authors.initials: HJ
authors.lastname: Hoekstra
authors.affiliation: H. Lee Moffitt Cancer Center, Tampa, USA.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Zager
authors.affiliation: NYU Langone Medical Center, New York, USA.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Roses
authors.affiliation: Istituto Europeo di Oncologia, Milano, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Testori
authors.affiliation: Royal Adelaide Hospital Discipline of Surgery, Royal Adelaide HospitalUniversity of Adelaide, Adelaide, SA, Australia.
authors.forename: Brendon J
authors.initials: BJ
authors.lastname: Coventry
authors.affiliation: Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
authors.forename: Mark B
authors.initials: MB
authors.lastname: Smithers
authors.affiliation: Huntsman Cancer Institute, Salt Lake City, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Andtbacka
authors.affiliation: Ohio State University, Columbus, USA.
authors.forename: Doreen
authors.initials: D
authors.lastname: Agnese
authors.affiliation: Nuremberg General Hospital - Paracelsus Medical University, Nuremberg, Germany.
authors.forename: Erwin
authors.initials: E
authors.lastname: Schultz
authors.affiliation: Saint Louis University, St. Louis, USA.
authors.forename: Eddy C
authors.initials: EC
authors.lastname: Hsueh
authors.affiliation: Vanderbilt University, Nashville, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Kelley
authors.affiliation: Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
authors.forename: Schlomo
authors.initials: S
authors.lastname: Schneebaum
authors.affiliation: Johns Hopkins Medical Institute, Baltimore, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Jacobs
authors.affiliation: IHC Cancer Services, Intermountain Medical Center, Salt Lake City, UT, USA.
authors.forename: Tawnya
authors.initials: T
authors.lastname: Bowles
authors.affiliation: California Pacific Medical Center, San Francisco, USA.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Kashani-Sabet
authors.affiliation: Vanderbilt University, Nashville, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Johnson
authors.affiliation: Department of Melanoma Research, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA. mark.faries@jwci.org.
authors.forename: Mark B
authors.initials: MB
authors.lastname: Faries
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007390:International Agencies; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D000071036:Sentinel Lymph Node / Q000473:pathology* / Q000601:surgery; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000209:etiology / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D012907:Smoking / Q000009:adverse effects*; D000096142:Cutaneous Malignant Melanoma