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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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