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Factors Predicting the Risk of In-Transit Recurrence After Sentinel Lymphonodectomy in Patients With Cutaneous Malignant Melanoma

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Abstract

Background

In-transit metastasis is an important morbidity factor after sentinel lymphonodectomy (SLNE). So far, factors posing an increased risk after SLNE have not been adequately analyzed.

Methods

Using Kaplan-Meier estimations and the Cox proportional hazards model, we analyzed the risk of developing in-transit metastases after SLNE for 328 consecutive patients (median tumor thickness, 2.0 mm; median follow-up period, 40 months).

Results

The 5-year probability of developing in-transit metastases as a first recurrence was 11.2%. After negative and positive SLNE, the probabilities were 6.3% and 24%, respectively. Patients in whom satellite metastases were excised concurrently with the primary tumor had a probability of recurrence with in-transit metastases of 41%. In sentinel lymph node (SLN)-negative patients with primary tumors having a thickness of more than 4 mm, the probability was 22.1%. Among the group of SLN-positive patients, significantly increased in-transit probabilities were observed in those with primary tumors that were thicker than 4 mm (41.8%), with tumors located on the distal extremities (42.1%), and with penetration of the nodal metastasis of >1 mm into the SLN (36%) and in patients with capsular breakthrough (63.3%). By using multifactorial analysis, the SLN status (P = .005), Breslow thickness (P = .0009), and extremity location of the primary melanoma (P = .005) significantly predicted the risk of in-transit recurrence. Satellite metastasis (P < .089), Clark level, and ulceration did not reach significance.

Conclusions

Subgroups of patients can be identified who seem to have an increased risk of developing in-transit metastases as a first recurrence after SLNE. Individualized therapeutic strategies should be developed for these patients.

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Authors and Affiliations

  1. Department of Dermatology, Georg-August-University Göttingen, v. Siebold-Str. 3, D-37075, Göttingen, Germany

    Lutz Kretschmer MD, Iris Beckmann MD, Kai-Martin Thoms MD, Christina Mitteldorf MD, Hans Peter Bertsch MD & Christine Neumann MD

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  1. Lutz Kretschmer MD
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  2. Iris Beckmann MD
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  3. Kai-Martin Thoms MD
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  4. Christina Mitteldorf MD
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  5. Hans Peter Bertsch MD
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  6. Christine Neumann MD
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Correspondence to Lutz Kretschmer MD.

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Kretschmer, L., Beckmann, I., Thoms, KM. et al. Factors Predicting the Risk of In-Transit Recurrence After Sentinel Lymphonodectomy in Patients With Cutaneous Malignant Melanoma. Ann Surg Oncol 13, 1105–1112 (2006). https://doi.org/10.1245/ASO.2006.07.020

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