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Sentinel and Nonsentinel Node Status in Stage IB and II Melanoma Patients: Two-Step Prognostic Indicators of Survival

Natale Cascinelli, Emilio Bombardieri, Rosaria Bufalino, Tiziana Camerini, Antonino Carbone, Claudio Clemente, Leonardo Lenisa, Luigi Mascheroni, Andrea Maurichi, Elisabetta Pennacchioli, Roberto Patuzzo, Mario Santinami, Gabrina Tragni

From the Nuclear Medicine Unit, Scientific Directorate, Pathology Unit, Istituto Nazionale Tumori, Milan; Pathology Unit, Unit of General Surgery, San Pio X Hospital; and the Melanoma and Sarcoma Unit, Istituto Nazionale Tumori, Milan, Italy

Address reprint requests to Natale Cascinelli, MD, Istituto Nazionale Tumori, via Venezian 1, 20133 Milan, Italy; e-mail: direzionescientifica{at}istitutotumori.mi.it

PURPOSE: To evaluate the prognostic significance of sentinel node biopsy in the management of stage IB and II melanoma patients, and to evaluate the status of nonsentinel nodes as a "second step key factor" to assess the prognosis of these patients.

PATIENTS AND METHODS: We conducted an analysis of data collected in a prospective database.

RESULTS: From February 1994 to June 2005, 1,108 consecutive patients with stage IB and II melanoma were submitted to sentinel node biopsy; 176 patients (15.9%) had occult node metastases. The frequency of positive nodes increased with increasing Breslow's thickness. The largest diameter of metastatic foci and their localization within the lymph node were associated with the risk of nonsentinel node metastases only. The 5-year survival of patients with positive sentinel nodes was 81.4% in patients with one positive node and 39.6% in patients with two positive nodes (P = .056). Multivariate analysis indicated that status of sentinel nodes is a key factor and that sex and Breslow's thickness maintain statistically significant relevance. Ulceration, which was associated with survival when considered as single factor (P < .001) had no impact on survival in the multivariate analysis (P = .10). To evaluate the relevance of metastases to nonsentinel nodes, we identified four groups of patients.

CONCLUSION: Evaluation of the sentinel node is a useful procedure to identify patients to be submitted for complete lymph node dissection. The procedure makes it possible to assess the best prognosis of patients.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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