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Mitotic Rate as a Predictor of Sentinel Lymph NodePositivity in Patients With Thin Melanomas

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Abstract

Background

Lymphatic mapping and sentinel lymphadenectomy (LM/SL) provide important prognostic information for patients with early-stage melanoma. Although the use of this technique in patients with thin melanomas (≤1.00 mm) is not routine, risk factors that may predict sentinel lymph node (SLN) positivity in this patient population are under investigation. We sought to determine whether mitotic rate (MR) is associated with SLN positivity in thin-melanoma patients and, therefore, whether it may be used to risk-stratify and select patients for LM/SL.

Methods

Clinical and histopathologic variables were reviewed for 181 patients with thin melanomas who underwent LM/SL from January 1996 through January 2004. Univariate and multivariate logistic regression analyses were performed to identify factors associated with SLN positivity. Risk groups were defined on the basis of the development of a classification tree.

Results

The overall SLN positivity rate was 5%. All patients with positive SLNs had an MR of >0. By univariate analysis, MR and thickness were significant predictors of SLN positivity. The association between MR and SLN positivity remained significant controlling for each of the other variables evaluated. On the basis of a classification tree, patients with an MR >0 and tumor thickness ≥.76 mm were identified as a higher-risk group, with an SLN positivity rate of 12.3%.

Conclusions

In patients with thin melanomas, MR >0 seems to be a significant predictor of SLN positivity that may be used to risk-stratify and select patients for LM/SL. To confirm these results, the predictive value of MR for SLN positivity needs to be validated in other populations of thin-melanoma patients.

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Acknowledgments

Supported by the SPORE on Skin Cancer (CA-093372; M. Herlyn, principal investigator).

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Authors and Affiliations

  1. Department of Surgery, Hospital of the University of Pennsylvania, 4th Floor, Silverstein Pavilion, 3400 Spruce Street, Philadelphia, Pennsylvania, 19104

    Susan B. Kesmodel MD, Giorgos C. Karakousis MD, Robert J. Canter MD, Robert T. Lewis BA, Kyla P. Terhune MD, Douglas L. Fraker MD, Brian J. Czerniecki MD, PhD & Francis R. Spitz MD

  2. Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, 631 Blockley Hall,423 Guardian Drive, Philadelphia, Pennsylvania, 19104

    Jeffrey D. Botbyl MS, Peter M. Wahl BA & Phyllis A. Gimotty PhD

  3. Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, Pennsylvania, 19104

    Abass Alavi MD

  4. Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 6th Floor, Founders Building, 3400 Spruce Street, Philadelphia, Pennsylvania, 19104

    David E. Elder MB, ChB

  5. Pigmented Lesion Group and Melanoma Program, Abramson Cancer Center of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, Pennsylvania, 19104

    David E. Elder MB, ChB, Michael E. Ming MD, MSCE, DuPont Guerry MD, Phyllis A. Gimotty PhD, Douglas L. Fraker MD & Brian J. Czerniecki MD, PhD

  6. Department of Dermatology, Hospital of the University of Pennsylvania, 2nd Floor, Rhoads Building , 3400 Spruce Street, Philadelphia, Pennsylvania, 19104

    Michael E. Ming MD, MSCE

  7. Department of Medicine, Division of Hematology and Oncology, Hospital of the University of Pennsylvania,519 Maloney Building, 3400 Spruce Street, Philadelphia, Pennsylvania, 19104

    DuPont Guerry MD

Authors
  1. Susan B. Kesmodel MD
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  2. Giorgos C. Karakousis MD
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  10. Michael E. Ming MD, MSCE
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Correspondence to Francis R. Spitz MD.

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Published by Springer Science+Business Media, Inc. © 2005 The Society of Surgical Oncology, Inc.

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Kesmodel, S.B., Karakousis, G.C., Botbyl, J.D. et al. Mitotic Rate as a Predictor of Sentinel Lymph NodePositivity in Patients With Thin Melanomas. Ann Surg Oncol 12, 449–458 (2005). https://doi.org/10.1245/ASO.2005.04.027

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