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Journal of Clinical Oncology, Vol 17, Issue 3 (March), 1999: 976
© 1999 American Society for Clinical Oncology

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

Jeffrey E. Gershenwald, William Thompson, Paul F. Mansfield, Jeffrey E. Lee, Maria I. Colome, Chi-hong Tseng, J. Jack Lee, Charles M. Balch, Douglas S. Reintgen, Merrick I. Ross

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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J. Clin. Oncol., April 1, 2003; 21(7): 1326 - 1331.
[Abstract] [Full Text] [PDF]

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 JCOHome page
R.J.C.L.M. Vuylsteke, P.A.M. van Leeuwen, M.G. S. Muller, H.A. Gietema, D.R. Kragt, and S. Meijer
Clinical Outcome of Stage I/II Melanoma Patients After Selective Sentinel Lymph Node Dissection: Long-Term Follow-Up Results
J. Clin. Oncol., March 15, 2003; 21(6): 1057 - 1065.
[Abstract] [Full Text] [PDF]

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 Mol. Pathol.Home page
V Davids, S H Kidson, and G S Hanekom
Accurate molecular detection of melanoma nodal metastases: an assessment of multimarker assay specificity, sensitivity, and detection rate
Mol. Pathol., February 1, 2003; 56(1): 43 - 51.
[Abstract] [Full Text] [PDF]

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 Arch DermatolHome page
K. M. McMasters, A. Sober, and J. M. Kirkwood
Sentinel Lymph Node Biopsy and Adjuvant Therapy for Melanoma: Evidence Revisited
Arch Dermatol, January 1, 2003; 139(1): 99 - 99.
[Full Text] [PDF]

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 Arch Otolaryngol Head Neck SurgHome page
C. E. Schmalbach, B. Nussenbaum, R. S. Rees, J. Schwartz, T. M. Johnson, and C. R. Bradford
Reliability of Sentinel Lymph Node Mapping With Biopsy for Head and Neck Cutaneous Melanoma
Arch Otolaryngol Head Neck Surg, January 1, 2003; 129(1): 61 - 65.
[Abstract] [Full Text] [PDF]

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 Arch SurgHome page
I. A. Jacobs, C. K. Chang, T. K. DasGupta, and G. Salti
High Isotope Counts and Sentinel Node Positivity in Patients With Melanoma
Arch Surg, January 1, 2003; 138(1): 63 - 66.
[Abstract] [Full Text] [PDF]

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 JNCI J Natl Cancer InstHome page
D. Polsky, K. Melzer, C. Hazan, K. S. Panageas, K. Busam, M. Drobnjak, H. Kamino, J. G. Spira, A. W. Kopf, A. Houghton, et al.
HDM2 Protein Overexpression and Prognosis in Primary Malignant Melanoma
J Natl Cancer Inst, December 4, 2002; 94(23): 1803 - 1806.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
F. E. Schmidt, E. A. Woltering, W. R. Webb, O. M. Garcia, J. E. Cohen, and M. H. Rozans
Sentinel nodal assessment in patients with carcinoma of the lung
Ann. Thorac. Surg., September 1, 2002; 74(3): 870 - 875.
[Abstract] [Full Text] [PDF]

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 BMJHome page
D Johnson and I H Whitworth
Recent developments in plastic surgery
BMJ, August 10, 2002; 325(7359): 319 - 322.
[Full Text] [PDF]

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 The OncologistHome page
T. Belhocine, G. Pierard, M. de Labrassinne, T. Lahaye, and P. Rigo
Staging of Regional Nodes in AJCC Stage I and II Melanoma: 18FDG PET Imaging versus Sentinel Node Detection
Oncologist, August 1, 2002; 7(4): 271 - 278.
[Abstract] [Full Text] [PDF]

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 Arch SurgHome page
K. M. McMasters, C. Chao, S. L. Wong, W. R. Wrightson, M. I. Ross, D. S. Reintgen, R. D. Noyes, P. B. Cerrito, M. J. Edwards, and for the Sunbelt Melanoma Trial Group
Interval Sentinel Lymph Nodes in Melanoma
Arch Surg, May 1, 2002; 137(5): 543 - 549.
[Abstract] [Full Text] [PDF]

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 JCOHome page
K. L. Kilbridge, B. F. Cole, J. M. Kirkwood, F. G. Haluska, M. A. Atkins, J. C. Ruckdeschel, D. E. Sock, R. F. Nease Jr, and J. C. Weeks
Quality-of-Life-Adjusted Survival Analysis of High-Dose Adjuvant Interferon Alfa-2b for High-Risk Melanoma Patients Using Intergroup Clinical Trial Data
J. Clin. Oncol., March 1, 2002; 20(5): 1311 - 1318.
[Abstract] [Full Text] [PDF]

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 Arch Otolaryngol Head Neck SurgHome page
S. A. Eicher, G. L. Clayman, J. N. Myers, and A. M. Gillenwater
A Prospective Study of Intraoperative Lymphatic Mapping for Head and Neck Cutaneous Melanoma
Arch Otolaryngol Head Neck Surg, March 1, 2002; 128(3): 241 - 246.
[Abstract] [Full Text] [PDF]

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 Arch SurgHome page
G. I. Salti, A. Kansagra, M. A. Warso, S. G. Ronan, and T. K. Das Gupta
Clinical Node-Negative Thick Melanoma
Arch Surg, March 1, 2002; 137(3): 291 - 295.
[Abstract] [Full Text] [PDF]

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 Ann OncolHome page
C. M. Balch and M. C. Mihm
Reply to the article "The AJCC staging proposal for cutaneous melanoma: comments by the EORTC Melanoma Group", by D. J. Ruiter et al. (Ann Oncol 2001; 12: 9-11)
Ann. Onc., January 19, 2002; 13(1): 175 - 176.
[Full Text] [PDF]

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 The OncologistHome page
J. E. Gershenwald
Melanoma
Oncologist, October 1, 2001; 6(5): 402 - 406.
[Abstract] [Full Text] [PDF]

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 J. Nucl. Med. Technol.Home page
O. Alonso, M. Martinez, G. Lago, and J. Espasandin
Preoperative Evaluation of Sentinel Lymph Node Status in Melanoma by Means of 99mTc-MIBI and Lymphoscintigraphy: A Case Report
J. Nucl. Med. Technol., September 1, 2001; 29(3): 152 - 153.
[Abstract] [Full Text] [PDF]

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

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 Arch DermatolHome page
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]

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 Arch DermatolHome page
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]

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 Arch DermatolHome page
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]

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 JCOHome page
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]

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 JCOHome page
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]

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 JCOHome page
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]

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

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 JCOHome page
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]

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 JNMHome page
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]

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 Arch DermatolHome page
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]

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 JCOHome page
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]

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 JCOHome page
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]

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 Ann. Thorac. Surg.Home page
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]

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 BMJHome page
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]

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 Arch Otolaryngol Head Neck SurgHome page
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]

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

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 Arch DermatolHome page
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]


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