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Annals of Surgical Oncology

, Volume 13, Issue 2, pp 198–204 | Cite as

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

  • Julio Vaquerano
  • William G. Kraybill
  • Deborah L. Driscoll
  • Richard Cheney
  • John M. KaneIII
Article

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.

Keywords

Thin melanoma Sentinel lymph node Clinical stage Prognostic factors 

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Copyright information

© The Society of Surgical Oncology, Inc. 2006

Authors and Affiliations

  • Julio Vaquerano
    • 1
  • William G. Kraybill
    • 1
  • Deborah L. Driscoll
    • 1
  • Richard Cheney
    • 2
  • John M. KaneIII
    • 1
  1. 1.Department of Surgical OncologyRoswell Park Cancer InstituteBuffalo
  2. 2.Department of PathologyRoswell Park Cancer InstituteBuffalo

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