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Multi-Institutional Melanoma Lymphatic Mapping Experience: The Prognostic Value of Sentinel Lymph Node Status in 612 Stage I or II Melanoma Patients

From the Departments of Surgical Oncology, Pathology, and Biomathematics, The University of Texas M.D. Anderson Cancer Center, Houston, TX; and the Cutaneous Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.

Address reprint requests to Merrick I. Ross, MD, Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 106, Houston, TX 77030.

PURPOSE: To compare the effect of pathologic sentinel lymph node (SLN) status with that of other known prognostic factors on recurrence and survival in patients with stage I or II cutaneous melanoma.

PATIENTS AND METHODS: We reviewed the records of 612 patients with primary cutaneous melanoma who underwent lymphatic mapping and SLN biopsy between January 1991 and May 1995 to determine the effects of tumor thickness, ulceration, Clark level, location, sex, and SLN pathologic status on disease-free and disease-specific survival.

RESULTS: In the 580 patients in whom lymphatic mapping and SLN biopsy were successful, the SLN was positive by conventional histology in 85 patients (15%) but negative in 495 patients (85%). SLN status was the most significant prognostic factor with respect to disease-free and disease-specific survival by univariate and multiple covariate analyses. Although tumor thickness and ulceration influenced survival in SLN-negative patients, they provided no additional prognostic information in SLN-positive patients.

CONCLUSION: Lymphatic mapping and SLN biopsy is highly accurate in staging nodal basins at risk for regional metastases in primary melanoma patients and identifies those who may benefit from earlier lymphadenectomy. Furthermore, pathologic status of the SLN in these patients with clinically negative nodes is the most important prognostic factor for recurrence. The information from SLN biopsy is particularly helpful in establishing stratification criteria for future adjuvant trials.

Presented at the 49th Annual Meeting of the Society of Surgical Oncology, Atlanta, GA, March 1996.

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				P J Ell A revolution in surgical oncology: sentinel lymph node biopsy Imaging, September 1, 2001; 13(3): 197 - 205. [Abstract] [Full Text] [PDF]

				M. Kashani-Sabet, R. W. Sagebiel, C. M. M. Ferreira, M. Nosrati, and J. R. Miller III Vascular Involvement in the Prognosis of Primary Cutaneous Melanoma Arch Dermatol, September 1, 2001; 137(9): 1169 - 1173. [Abstract] [Full Text] [PDF]

				R. W. Dubois, S. M. Swetter, M. Atkins, K. McMasters, R. Halbert, S. J. Miller, R. Shiell, and J. Kirkwood Developing Indications for the Use of Sentinel Lymph Node Biopsy and Adjuvant High-Dose Interferon Alfa-2b in Melanoma Arch Dermatol, September 1, 2001; 137(9): 1217 - 1224. [Abstract] [Full Text] [PDF]

				J. Connors, B. Smoller, and S. Dinehart Sentinel Node Biopsy for Melanoma: What Is the Evidence? Arch Dermatol, September 1, 2001; 137(9): 1228 - 1231. [Full Text] [PDF]

				C. M. Balch, S.-J. Soong, J. E. Gershenwald, J. F. Thompson, D. S. Reintgen, N. Cascinelli, M. Urist, K. M. McMasters, M. I. Ross, J. M. Kirkwood, et al. Prognostic Factors Analysis of 17,600 Melanoma Patients: Validation of the American Joint Committee on Cancer Melanoma Staging System J. Clin. Oncol., August 15, 2001; 19(16): 3622 - 3634. [Abstract] [Full Text] [PDF]

				C. M. Balch, A. C. Buzaid, S.-J. Soong, M. B. Atkins, N. Cascinelli, D. G. Coit, I. D. Fleming, J. E. Gershenwald, A. Houghton Jr, J. M. Kirkwood, et al. Final Version of the American Joint Committee on Cancer Staging System for Cutaneous Melanoma J. Clin. Oncol., August 15, 2001; 19(16): 3635 - 3648. [Abstract] [Full Text] [PDF]

				K. M. McMasters, D. S. Reintgen, M. I. Ross, J. E. Gershenwald, M. J. Edwards, A. Sober, N. Fenske, F. Glass, C. M. Balch, and D. G. Coit Sentinel Lymph Node Biopsy for Melanoma: Controversy Despite Widespread Agreement J. Clin. Oncol., June 1, 2001; 19(11): 2851 - 2855. [Abstract] [Full Text] [PDF]

				R Allan Sentinel node localization: do or dye alone? Br. J. Radiol., June 1, 2001; 74(882): 475 - 477. [Full Text] [PDF]

				K.M. Acland, C. Healy, E. Calonje, M. O'Doherty, T. Nunan, C. Page, E. Higgins, and R. Russell-Jones Comparison of Positron Emission Tomography Scanning and Sentinel Node Biopsy in the Detection of Micrometastases of Primary Cutaneous Malignant Melanoma J. Clin. Oncol., May 15, 2001; 19(10): 2674 - 2678. [Abstract] [Full Text] [PDF]

				R. A. Valdés Olmos and O. E. Nieweg Reproducibility of Cutaneous Lymphoscintigraphy: Same or Different Lymphatic Routes and Sentinel Nodes After Reinjection? J. Nucl. Med., March 1, 2001; 42(3): 430 - 431. [Full Text]

				B. Coldiron and S. P. L. Leong No Evidence to Support Delay in Excision of Malignant Melanoma Arch Dermatol, October 1, 2000; 136(10): 1269 - 1270. [Full Text] [PDF]

				B. Cady Sentinel Lymph Node Procedure in Squamous Cell Carcinoma of the Vulva J. Clin. Oncol., August 15, 2000; 18(15): 2795 - 2797. [Full Text] [PDF]

				J. A. de Hullu, H. Hollema, D. A. Piers, R. H. M. Verheijen, P. J. van Diest, M. J. E. Mourits, J. G. Aalders, and A. G. J. van der Zee Sentinel Lymph Node Procedure Is Highly Accurate in Squamous Cell Carcinoma of the Vulva J. Clin. Oncol., August 15, 2000; 18(15): 2811 - 2816. [Abstract] [Full Text] [PDF]

				M. J. Liptay, G. A. Masters, D. J. Winchester, B. L. Edelman, B. J. Garrido, T. R. Hirschtritt, R. M. Perlman, and W. A. Fry Intraoperative radioisotope sentinel lymph node mapping in non-small cell lung cancer Ann. Thorac. Surg., August 1, 2000; 70(2): 384 - 389. [Abstract] [Full Text] [PDF]

				J M. Thomas and E. J Patocskai The argument against sentinel node biopsy for malignant melanoma BMJ, July 1, 2000; 321(7252): 3 - 4. [Full Text]

				J. D. Wagner, H.-M. Park, J. J. Coleman III, C. Love, and J. T. Hayes Cervical Sentinel Lymph Node Biopsy for Melanomas of the Head and Neck and Upper Thorax Arch Otolaryngol Head Neck Surg, March 1, 2000; 126(3): 313 - 321. [Abstract] [Full Text] [PDF]

				R. M. MacKie Melanoma and the Dermatologist in the Third Millennium Arch Dermatol, January 1, 2000; 136(1): 71 - 73. [Full Text] [PDF]

				S. P. L. Leong, T. A. Achtem, F. A. Habib, I. Steinmetz, E. Morita, R. E. Allen, M. Kashani-Sabet, and R. Sagebiel Discordancy Between Clinical Predictions vs Lymphoscintigraphic and Intraoperative Mapping of Sentinel Lymph Node Drainage of Primary Melanoma Arch Dermatol, December 1, 1999; 135(12): 1472 - 1476. [Abstract] [Full Text] [PDF]