Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Sentinel Lymph Node Positivity Markers in Melanoma

J Am Acad Dermatol; ePub 2018 Sep 18; Conic, et al

Younger age, Breslow thickness >0.8 mm, presence of dermal mitoses, ulceration, and Clark level IV-V are positive predictors of positive sentinel lymph node (SLN), according to a recent study. While the new American Joint Committee on Cancer (AJCC) system has removed dermal mitotic rate from staging, continued evaluation of dermal mitotic rate could be valuable for guiding surgical decision making about SLN biopsy (SLNB). Patients with cutaneous melanoma, Breslow thickness ≤1.00 mm, who received a SLNB were identified from the National Cancer Database in the period from 2004-2014 (n=9,186). Predictors of SLNB positivity were analyzed using logistic regression. Researchers found:

  • In a multivariate analysis, patients aged <60 years with Breslow thickness >0.8mm were at increased risk for positive SLN.
  • Moreover, on multivariate analysis, presence dermal mitoses increased odds of SLN positivity by 95% (OR 1.95), ulceration by 63% (OR 1.63), and Clark level IV-V by 48% (OR 1.48).
  • Patients without ulceration but with dermal mitoses had 92% (OR 1.92) increased SLN positivity.
Citation:

Conic RZ, Ko J, Damiani G, et al. Predictors of sentinel lymph node positivity in thin melanoma using the National Cancer Database. [Published online ahead of print September 18, 2018]. J Am Acad Dermatol. doi:10.1016/j.jaad.2018.08.051.