Skip to main content
SpringerLink
Log in

American Joint Committee on Cancer Clinical Stage as a Selection Criterion for Sentinel Lymph Node Biopsy in Thin Melanoma

  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

A significant proportion of newly diagnosed melanomas are thin lesions (≤1.00 mm). Because tumor thickness correlates with the risk for nodal metastases, sentinel lymph node (SLN) biopsy in this subset is controversial. Incorporating other prognostic factors (Clark level and ulceration), we evaluated the 6th edition American Joint Committee on Cancer (AJCC) clinical stage as a simple and widely applicable guideline for offering SLN biopsy for thin melanoma.

Methods

This study was a review of a prospective melanoma SLN database from 1993 to 2003 with emphasis on SLN positivity rates based on the 6th edition AJCC primary tumor thickness intervals and clinical stage.

Results

Three hundred five patients underwent SLN biopsy, with an overall positivity rate of 17.7%. By the 6th edition AJCC, lesions ≤1.00 mm had an SLN positivity rate of 6.6%. By 6th edition clinical stage, SLN positivity rates were 4.9% for stage IA and 10.4% for stage IB. By using stage IA as the criterion for not offering SLN biopsy, this procedure would have been avoided in 46% (39 of 85) of ≤1.00-mm melanoma patients with a negative SLN.

Conclusions

Sixth edition AJCC clinical stage IB as a selection criterion for performing SLN biopsy in thin melanoma identifies most patients with a positive SLN while also avoiding a negative SLN biopsy in many patients. Until additional widely accepted and validated selection criteria are available, SLN biopsy for clinical stage IB, but not stage IA, thin melanomas is a reasonable approach.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Balch CM, Soong SJ, Gershenwald JE, et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol 2001;19:3622–34

    CAS  PubMed  Google Scholar 

  2. Kirkwood JM, Strawderman MH, Ernstoff MS, et al. Interferon alfa-2b adjuvant therapy of high-risk resected cutaneous melanoma: the Eastern Cooperative Oncology Group Trial EST 1684. J Clin Oncol 1996;14:7–17

    CAS  PubMed  Google Scholar 

  3. Kirkwood JM, Ibrahim JG, Sondak VK, et al. High- and low-dose interferon alfa-2b in high-risk melanoma: first analysis of intergroup trial E1690/S9111/C9190. J Clin Oncol 2000;18:2444–58

    CAS  PubMed  Google Scholar 

  4. Morton DL, Hsueh EC, Essner R, et al. Prolonged survival of patients receiving active immunotherapy with Canvaxin therapeutic polyvalent vaccine after complete resection of melanoma metastatic to regional lymph nodes. Ann Surg 2002;236:438–48; discussion 448–9

    Article  PubMed  Google Scholar 

  5. Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992;127:392–9

    CAS  PubMed  Google Scholar 

  6. Agnese DM, Abdessalam SF, Burak WE Jr, et al. Cost-effectiveness of sentinel lymph node biopsy in thin melanomas. Surgery 2003;134:542–7; discussion 547–8

    Article  PubMed  Google Scholar 

  7. Bleicher RJ, Essner R, Foshag LJ, et al. Role of sentinel lymphadenectomy in thin invasive cutaneous melanomas. J Clin Oncol 2003;21:1326–31

    Article  PubMed  Google Scholar 

  8. Jacobs IA, Chang CK, DasGupta TK, Salti GI. Role of sentinel lymph node biopsy in patients with thin (<1 mm) primary melanoma. Ann Surg Oncol 2003;10:558–61

    Article  PubMed  Google Scholar 

  9. Stitzenberg KB, Groben PA, Stern SL, et al. Indications for lymphatic mapping and sentinel lymphadenectomy in patients with thin melanoma (Breslow thickness < or =1.0 mm). Ann Surg Oncol 2004;11:900–6

    Article  PubMed  Google Scholar 

  10. Bedrosian I, Faries MB, Guerry DT, et al. Incidence of sentinel node metastasis in patients with thin primary melanoma (< or = 1 mm) with vertical growth phase. Ann Surg Oncol 2000;7:262–7

    Article  CAS  PubMed  Google Scholar 

  11. Lowe JB, Hurst E, Moley JF, Cornelius LA. Sentinel lymph node biopsy in patients with thin melanoma. Arch Dermatol 2003;139:617–21

    Article  PubMed  Google Scholar 

  12. Oliveira Filho RS, Ferreira LM, Biasi LJ, et al. Vertical growth phase and positive sentinel node in thin melanoma. Braz J Med Biol Res 2003;36:347–50

    Article  CAS  PubMed  Google Scholar 

  13. Vuylsteke RJ, van Leeuwen PA, Statius Muller MG, et al. Clinical outcome of stage I/II melanoma patients after selective sentinel lymph node dissection: long-term follow-up results. J Clin Oncol 2003;21:1057–65

    Article  CAS  PubMed  Google Scholar 

  14. Nahabedian MY, Tufaro AP, Manson PN. Sentinel lymph node biopsy for the T1 (thin) melanoma: is it necessary? Ann Plast Surg 2003;50:601–6

    PubMed  Google Scholar 

  15. Statius Muller MG, van Leeuwen PA, van Diest PJ, et al. No indication for performing sentinel node biopsy in melanoma patients with a Breslow thickness of less than 0.9 mm. Melanoma Res 2001;11:303–7

    CAS  PubMed  Google Scholar 

  16. Rousseau DL Jr, Ross MI, Johnson MM, et al. Revised American Joint Committee on Cancer staging criteria accurately predict sentinel lymph node positivity in clinically node-negative melanoma patients. Ann Surg Oncol 2003;10:569–74

    Article  PubMed  Google Scholar 

  17. Slingluff CL Jr, Vollmer RT, Reintgen DS, Seigler HF. Lethal “thin” malignant melanoma. Identifying patients at risk. Ann Surg 1988;208:150–61

    PubMed  Google Scholar 

  18. Blessing K, McLaren KM, McLean A, Davidson P. Thin malignant melanomas (less than 1.5 mm) with metastasis: a histological study and survival analysis. Histopathology 1990;17:389–95

    CAS  PubMed  Google Scholar 

  19. McMasters KM, Wong SL, Edwards MJ, et al. Factors that predict the presence of sentinel lymph node metastasis in patients with melanoma. Surgery 2001;130:151–6

    Article  CAS  PubMed  Google Scholar 

  20. Sondak VK, Taylor JM, Sabel MS, et al. Mitotic rate and younger age are predictors of sentinel lymph node positivity: lessons learned from the generation of a probabilistic model. Ann Surg Oncol 2004;11:247–58

    Article  PubMed  Google Scholar 

  21. Balch CM, Buzaid AC, Soong SJ, et al. Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. J Clin Oncol 2001;19:3635–48

    CAS  PubMed  Google Scholar 

  22. Sabel MS, Gibbs JF, Cheney R, et al. Evolution of sentinel lymph node biopsy for melanoma at a National Cancer Institute-designated cancer center. Surgery 2000;128:556–63

    Article  CAS  PubMed  Google Scholar 

  23. Zapas JL, Coley HC, Beam SL, et al. The risk of regional lymph node metastases in patients with melanoma less than 1.0 mm thick: recommendations for sentinel lymph node biopsy. J Am Coll Surg 2003;197:403–7

    Article  PubMed  Google Scholar 

  24. Statius Muller MG, van Leeuwen PA, de Lange-De Klerk ES, et al. The sentinel lymph node status is an important factor for predicting clinical outcome in patients with stage I or II cutaneous melanoma. Cancer 2001;91:2401–8

    Article  CAS  PubMed  Google Scholar 

  25. Gimotty PA, Guerry D, Ming ME, et al. Thin primary cutaneous malignant melanoma: a prognostic tree for 10-year metastasis is more accurate than American Joint Committee on Cancer staging. J Clin Oncol 2004;22:3668–76

    Article  PubMed  Google Scholar 

  26. Clark WH Jr, Elder DE, Guerry DT, et al. Model predicting survival in stage I melanoma based on tumor progression. J Natl Cancer Inst 1989;81:1893–904

    PubMed  Google Scholar 

  27. Azzola MF, Shaw HM, Thompson JF, et al. Tumor mitotic rate is a more powerful prognostic indicator than ulceration in patients with primary cutaneous melanoma: an analysis of 3661 patients from a single center. Cancer 2003;97:1488–98

    Article  PubMed  Google Scholar 

  28. Francken AB, Shaw HM, Thompson JF, et al. The prognostic importance of tumor mitotic rate confirmed in 1317 patients with primary cutaneous melanoma and long follow-up. Ann Surg Oncol 2004;11:426–33

    Article  PubMed  Google Scholar 

  29. Balch CM, Soong SJ, Bartolucci AA, et al. Efficacy of an elective regional lymph node dissection of 1 to 4 mm thick melanomas for patients 60 years of age and younger. Ann Surg 1996;224:255–63; discussion 263–6

    Article  CAS  PubMed  Google Scholar 

  30. Cascinelli N, Morabito A, Santinami M, et al. Immediate or delayed dissection of regional nodes in patients with melanoma of the trunk: a randomised trial. WHO Melanoma Programme. Lancet 1998;351:793–6

    CAS  PubMed  Google Scholar 

  31. Gershenwald JE, Thompson W, Mansfield PF, et al. Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients. J Clin Oncol 1999;17:976–83

    CAS  PubMed  Google Scholar 

  32. Cascinelli N, Belli F, Santinami M, et al. Sentinel lymph node biopsy in cutaneous melanoma: the WHO Melanoma Program experience. Ann Surg Oncol 2000;7:469–74

    Article  CAS  PubMed  Google Scholar 

  33. Estourgie SH, Nieweg OE, Valdes Olmos RA, et al. Review and evaluation of sentinel node procedures in 250 melanoma patients with a median follow-up of 6 years. Ann Surg Oncol 2003;10:681–8

    PubMed  Google Scholar 

  34. Wrightson WR, Wong SL, Edwards MJ, et al. Complications associated with sentinel lymph node biopsy for melanoma. Ann Surg Oncol 2003;10:676–80

    Article  PubMed  Google Scholar 

  35. Morton DL, Thompson JF, Essner R, et al. Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: a multicenter trial. Multicenter Selective Lymphadenectomy Trial Group. Ann Surg 1999;230:453–63; discussion 463–5

    Article  CAS  PubMed  Google Scholar 

  36. Scolyer RA, Thompson JF, Li LX, et al. Failure to remove true sentinel nodes can cause failure of the sentinel node biopsy technique: evidence from antimony concentrations in false-negative sentinel nodes from melanoma patients. Ann Surg Oncol 2004;11(3 Suppl):174S–178S

    PubMed  Google Scholar 

  37. Wagner JD, Ranieri J, Evdokimow DZ, et al. Patterns of initial recurrence and prognosis after sentinel lymph node biopsy and selective lymphadenectomy for melanoma. Plast Reconstr Surg 2003;112:486–97

    PubMed  Google Scholar 

  38. Jacobs IA, Chevinsky AH, Swayne LC, et al. Gamma probe-directed lymphatic mapping and sentinel lymphadenectomy in primary melanoma: reliability of the procedure and analysis of failures after long-term follow-up. J Surg Oncol 2001;77:157–64

    Article  CAS  PubMed  Google Scholar 

  39. Statius Muller MG, Borgstein PJ, Pijpers R, et al. Reliability of the sentinel node procedure in melanoma patients: analysis of failures after long-term follow-up. Ann Surg Oncol 2000;7:461–8

    CAS  PubMed  Google Scholar 

  40. Ribuffo D, Gradilone A, Vonella M, et al. Prognostic significance of reverse transcriptase-polymerase chain reaction-negative sentinel nodes in malignant melanoma. Ann Surg Oncol 2003;10:396–402

    Article  PubMed  Google Scholar 

  41. Bostick PJ, Morton DL, Turner RR, et al. Prognostic significance of occult metastases detected by sentinel lymphadenectomy and reverse transcriptase-polymerase chain reaction in early-stage melanoma patients. J Clin Oncol 1999;17:3238–44

    CAS  PubMed  Google Scholar 

  42. Shivers SC, Wang X, Li W, et al. Molecular staging of malignant melanoma: correlation with clinical outcome. JAMA 1998;280:1410–5

    Article  CAS  PubMed  Google Scholar 

  43. Blaheta HJ, Schittek B, Breuninger H, et al. Detection of melanoma micrometastasis in sentinel nodes by reverse transcription-polymerase chain reaction correlates with tumor thickness and is predictive of micrometastatic disease in the lymph node basin. Am J Surg Pathol 1999;23:822–8

    Article  CAS  PubMed  Google Scholar 

  44. Thompson JF, Shaw HM. Should tumor mitotic rate and patient age, as well as tumor thickness, be used to select melanoma patients for sentinel node biopsy? Ann Surg Oncol 2004;11:233–5

    Article  PubMed  Google Scholar 

  45. Chao C, Martin RC II, Ross MI, et al. Correlation between prognostic factors and increasing age in melanoma. Ann Surg Oncol 2004;11:259–64

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, New York, 14263

    Julio Vaquerano MD, William G. Kraybill MD, Deborah L. Driscoll BA & John M. Kane III MD

  2. Department of Pathology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, New York, 14263

    Richard Cheney MD

Authors
  1. Julio Vaquerano MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. William G. Kraybill MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Deborah L. Driscoll BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Richard Cheney MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John M. Kane III MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John M. Kane III MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vaquerano, J., Kraybill, W.G., Driscoll, D.L. et al. American Joint Committee on Cancer Clinical Stage as a Selection Criterion for Sentinel Lymph Node Biopsy in Thin Melanoma. Ann Surg Oncol 13, 198–204 (2006). https://doi.org/10.1245/ASO.2006.03.092

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/ASO.2006.03.092

Keywords

Search

Navigation