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Annals of Surgical Oncology

, Volume 16, Issue 5, pp 1176–1183 | Cite as

Microscopic Satellitosis in Patients with Primary Cutaneous Melanoma: Implications for Nodal Basin Staging

  • Troy F. Kimsey
  • T. Cohen
  • A. Patel
  • K. J. Busam
  • M. S. Brady
Melanomas

Abstract

Background

Microscopic satellitosis in melanoma is uncommon. The role of regional basin staging/therapy in patients with this high-risk feature has not been well defined.

Methods

Patients presenting from 1996 to 2005 with clinically localized melanoma containing microscopic satellitosis were identified from a prospective, single-institution database. Multiple factors were analyzed to determine their predictive value for recurrence. The management of the draining nodal basin was evaluated to determine its impact on recurrence and survival.

Results

Thirty-eight patients presented to our institution during this time period with clinically localized melanoma containing microscopic satellitosis. The 5-year overall and disease-free survivals in these patients were 34% and 18%, respectively. Sixty-eight percent had pathologically involved regional nodal metastases. With median follow-up of 21 months, 68% recurred, with a median time to recurrence of 9 months. Lymphovascular invasion (LVI) (p = 0.01), tumor regression (p = 0.04), and positive regional lymph nodes (p = 0.02) were associated with an increased risk of recurrence. Of the 31 patients who underwent sentinel lymph node (SLN) biopsy, 22 had metastasis in the SLN (71%). Fifteen of these patients underwent completion lymphadenectomy (CLND) and seven were observed. There was no difference in disease-free survival (DFS), disease-specific survival (DSS), or overall survival (OS) between these groups (p = 0.42).

Conclusions

Pathological lymph node metastases were more prevalent (68%) than in any group previously defined. Regional nodal status predicted recurrence but not nodal recurrence. In SLN-positive patients, CLND did not improve DFS, DSS, or OS, although the number of patients was small. Further studies are needed to determine the utility of regional nodal staging/therapy in these high-risk patients.

Keywords

Melanoma Sentinel Lymph Node Sentinel Lymph Node Biopsy Wide Local Excision Positive Sentinel Lymph Node 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Jemal AA, Siegel RR, Ward EE, Hao Y, Xu J, Murray T, et al. Cancer statistics, 2008. CA Cancer J Clin. 2008;58:71–96.PubMedCrossRefGoogle Scholar
  2. 2.
    Clary BM, Mann B, Brady MS, Lewis JJ, Coit DG. Early recurrence after lymphatic mapping and sentinel node biopsy in patients with primary extremity melanoma: a comparison with elective lymph node dissection. Ann Surg Oncol. 2001;8:328–37.PubMedCrossRefGoogle Scholar
  3. 3.
    Gadd MA, Coit DG. Recurrence patterns and outcome in 1019 patients undergoing axillary or inguinal lymphadenectomy for melanoma. Arch Surg. 1992;127:1412–6.PubMedGoogle Scholar
  4. 4.
    Gershenwald JE, Colome MI, Lee JE, Mansfield PF, Tseng C, Lee JJ, et al. Patterns of recurrence following a negative sentinel lymph node biopsy in 243 patients with stage I or II melanoma. J Clin Oncol. 1998;16:2253–60.PubMedGoogle Scholar
  5. 5.
    Stadelmann WK, Reintgen DS. Prognosis in malignant melanoma. Hematol Oncol Clin North Am. 1998;12:767–96, viPubMedCrossRefGoogle Scholar
  6. 6.
    Balch CM, Buzaid AC, Soong SJ, Atkins MB, Cascinelli N, Coit DG, et al. New TNM melanoma staging system: linking biology and natural history to clinical outcomes. Semin Surg Oncol. 2003;21:43–52.PubMedCrossRefGoogle Scholar
  7. 7.
    Balch CM, Soong SJ, Gershenwald JE, Thompson JF, Reintgen DS, Cascinelli N, 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.PubMedGoogle Scholar
  8. 8.
    Morton DL, Wanek L, Nizze JA, Elashoff RM, Wong JH. Improved long-term survival after lymphadenectomy of melanoma metastatic to regional nodes. Analysis of prognostic factors in 1134 patients from the John Wayne Cancer Clinic. Ann Surg. 1991;214:491–9; discussion 499–501.PubMedCrossRefGoogle Scholar
  9. 9.
    Day CL Jr, Harrist TJ, Gorstein F, Sober AJ, Lew RA, Friedman RJ, et al. Malignant melanoma. Prognostic significance of “microscopic satellites” in the reticular dermis and subcutaneous fat. Ann Surg. 1981;194:108–12.PubMedCrossRefGoogle Scholar
  10. 10.
    Harrist TJ, Rigel DS, Day CL Jr, Sober AJ, Lew RA, Rhodes AR, et al. “Microscopic satellites” are more highly associated with regional lymph node metastases than is primary melanoma thickness. Cancer. 1984;53:2183–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Leon P, Daly JM, Synnestvedt M, Schultz DJ, Elder DE, Clark WH Jr. The prognostic implications of microscopic satellites in patients with clinical stage I melanoma. Arch Surg. 1991;126:1461–8.PubMedGoogle Scholar
  12. 12.
    Buzaid AC, Ross MI, Balch CM, Soong S, McCarthy WH, Tinoco L, et al. Critical analysis of the current American Joint Committee on Cancer staging system for cutaneous melanoma and proposal of a new staging system. J Clin Oncol. 1997;15:1039–51.PubMedGoogle Scholar
  13. 13.
    Balch CM, Soong SJ, Atkins MB, Buzaid AC, Cascinelli N, Coit DG, et al. An evidence-based staging system for cutaneous melanoma. CA Cancer J Clin. 2004;54:131–49; quiz 182–34.PubMedCrossRefGoogle Scholar
  14. 14.
    Cooper PH, Wanebo HJ, Hagar RW. Regression in thin malignant melanoma. Microscopic diagnosis and prognostic importance. Arch Dermatol. 1985;121:1127–31.PubMedCrossRefGoogle Scholar
  15. 15.
    Harrell FE Jr, Lee KL, Matchar DB, Reichert TA. Regression models for prognostic prediction: advantages, problems, and suggested solutions. Cancer Treat Rep. 1985;69:1071–7.PubMedGoogle Scholar
  16. 16.
    Harrell FE Jr, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15:361–87.PubMedCrossRefGoogle Scholar
  17. 17.
    Cascinelli N, Bufalino R, Marolda R, Belli F, Nava M, Galluzzo D, et al. Regional non-nodal metastases of cutaneous melanoma. Eur J Surg Oncol. 1986;12:175–80.PubMedGoogle Scholar
  18. 18.
    Coit DG, Rogatko A, Brennan MF. Prognostic factors in patients with melanoma metastatic to axillary or inguinal lymph nodes. A multivariate analysis. Ann Surg. 1991;214:627–36.PubMedCrossRefGoogle Scholar
  19. 19.
    Creagan ET, Dalton RJ, Ahmann DL, Jung SH, Morton RF, Langdon RM Jr, et al. Randomized, surgical adjuvant clinical trial of recombinant interferon alfa-2a in selected patients with malignant melanoma. J Clin Oncol. 1995;13:2776–83.PubMedGoogle Scholar
  20. 20.
    Haffner AC, Garbe C, Burg G, Büttner P, Orfanos CE, Rassner G, et al. The prognosis of primary and metastasising melanoma. An evaluation of the TNM classification in 2,495 patients. Br J Cancer. 1992;66:856–61.PubMedGoogle Scholar
  21. 21.
    Karakousis CP, Temple DF, Moore R, Ambrus JL. Prognostic parameters in recurrent malignant melanoma. Cancer. 1983;52:575–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Roses DF, Karp NS, Oratz R, Dubin N, Harris MN, Speyer J, et al. Survival with regional and distant metastases from cutaneous malignant melanoma. Surg Gynecol Obstet. 1991;172:262–8.PubMedGoogle Scholar
  23. 23.
    Sutherland CM, Mather FJ, Krementz ET. Factors influencing the survival of patients with regional melanoma of the extremity treated by perfusion. Surg Gynecol Obstet. 1987;164:111–8.PubMedGoogle Scholar
  24. 24.
    Cascinelli N, Bombardieri E, Bufalino R, Camerini T, Carbone A, Clemente C, et al. Sentinel and nonsentinel node status in stage IB and II melanoma patients: two-step prognostic indicators of survival. J Clin Oncol. 2006;24:4464–71.PubMedCrossRefGoogle Scholar
  25. 25.
    Cochran AJ, Wen DR, Huang RR, Wang HJ, Elashoff R, Morton DL. Prediction of metastatic melanoma in nonsentinel nodes and clinical outcome based on the primary melanoma and the sentinel node. Mod Pathol. 2004;17:747–55.PubMedCrossRefGoogle Scholar
  26. 26.
    Ariyan C, Brady MS, Gonen M, Busam K, Coit D. Positive nonsentinel node status predicts mortality in patients with cutaneous melanoma. Ann Surg Oncol. 2009;16(1):186–90.PubMedCrossRefGoogle Scholar
  27. 27.
    Crowson AN, Magro C, Miller A, Mihm MC Jr. The molecular basis of melanomagenesis and the metastatic phenotype. Semin Oncol. 2007;34:476–90.PubMedCrossRefGoogle Scholar
  28. 28.
    Polak ME, Borthwick NJ, Gabriel FG, Johnson P, Higgins B, Hurren J, et al. Mechanisms of local immunosuppression in cutaneous melanoma. Br J Cancer. 2007;96:1879–87.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2009

Authors and Affiliations

  • Troy F. Kimsey
    • 1
    • 2
  • T. Cohen
    • 1
  • A. Patel
    • 1
  • K. J. Busam
    • 3
  • M. S. Brady
    • 1
  1. 1.Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Surgical OncologyPhoebe Cancer CenterAlbanyUSA
  3. 3.Department of PathologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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