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Published on: June 1, 2019
Vertical growth phase and positive sentinel node in thin melanoma
R S Oliveira Filho1, L M Ferreira, L J Biasi
1Disciplina de Cirurgia Plástica, Departamento de Cirurgia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil. rehato.dcir@epm.br
Summary
Sentinel lymph node biopsy is crucial for thin melanoma prognosis. Ulceration, high mitotic rate, and vertical growth phase predict metastasis in thin melanoma patients, suggesting wider SN biopsy inclusion.
Area of Science:
- Oncology
- Dermatology
- Surgical Pathology
Background:
- Sentinel lymph node (SN) status is a key prognostic factor in localized melanoma.
- Thin melanomas (<1.0 mm) are typically excluded from SN biopsy protocols, despite reported nodal recurrence rates of 3-7%.
Purpose of the Study:
- To correlate specific pathological features of thin melanoma with sentinel lymph node (SN) metastasis.
- To evaluate the utility of SN biopsy in patients with thin melanoma.
Main Methods:
- Retrospective review of 358 patients undergoing SN biopsy, with 77 patients having lesions ≤1 mm.
- Histological evaluation included tumor thickness, Clark level, mitotic rate, ulceration, regression, and growth phase.
- Lymphoscintigraphy, lymphatic mapping, and gamma probe detection were used for SN biopsy; SNs were examined via H&E and immunohistochemistry.
Main Results:
- Six out of 77 patients with thin melanoma had SN micrometastases.
- Ulceration (P=0.019), high mitotic rate (P=0.008), and vertical growth phase (P=0.002) were significantly correlated with SN metastasis.
Conclusions:
- Pathological features like ulceration, high mitotic rate, and vertical growth phase are associated with SN metastasis in thin melanoma.
- These findings suggest that a broader application of sentinel lymph node biopsy may be warranted for select thin melanoma patients.
