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Sentinel lymph node biopsy in patients with thin melanomas.

Roberto Cecchi¹, Lauro Buralli, Stefania Innocenti

¹Department of Dermatology, Pistoia Hospital, Pistoia, Italy. r.cecchi@usl3.toscana.it

The Journal of Dermatology

|August 9, 2007

Summary

Lymphatic mapping and sentinel lymph node biopsy (SLNB) are not routinely recommended for melanomas thinner than 0.75 mm. SLNB is indicated for thin melanomas (<1.0 mm) with ulceration or high Clark levels, according to AJCC/UICC criteria.

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Area of Science:

Dermatology
Surgical Oncology
Pathology

Background:

Thin primary cutaneous melanomas (<1.0 mm) present a diagnostic challenge regarding the need for sentinel lymph node biopsy (SLNB).
Accurate staging is crucial for guiding treatment decisions and predicting prognosis in melanoma patients.

Purpose of the Study:

To evaluate the utility of lymphatic mapping (LM) and SLNB in a cohort of patients with thin primary cutaneous melanomas.
To assess the accuracy of current American Joint Committee on Cancer/International Union Against Cancer (AJCC/UICC) criteria for SLNB indication in thin melanomas.

Main Methods:

Fifty patients with thin melanomas (0.24-1.00 mm thickness) underwent LM/SLNB.
Patient data including Clark level, ulceration, and regression were analyzed.

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Follow-up data on disease recurrence and survival were collected.

Main Results:

Sentinel lymph node (SLN) metastases were identified in 4% of patients (2 out of 50).
Both positive cases involved melanomas thicker than 0.85 mm with high Clark levels.
Patients with negative SLN had a median disease-free follow-up of 44 months.

Conclusions:

LM/SLNB is not routinely indicated for melanomas less than 0.75 mm in thickness.
Current AJCC/UICC criteria accurately identify thin melanomas (<1.0 mm) requiring SLNB, particularly those with ulceration or Clark level IV/V invasion.