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Minimal melanoma spread to sentinel lymph nodes, quantified by disseminated cancer cells (DCCs), significantly impacts survival. Higher DCC density (DCCD) predicts increased melanoma mortality, even at low levels, offering a more precise prognostic tool.

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Area of Science:

  • Oncology
  • Dermatology
  • Pathology

Background:

  • Sentinel lymph node (SLN) status is critical for melanoma prognosis.
  • Minimal cancer spread and the number of disseminated cancer cells (DCCs) in SLNs require further investigation for their impact on melanoma-specific survival.

Purpose of the Study:

  • To determine the impact of minimal cancer spread and increasing numbers of DCCs on melanoma-specific survival.
  • To evaluate the prognostic value of quantitative immunocytology for melanoma.

Main Methods:

  • Analysis of 1,834 SLNs from 1,027 patients with ultrasound node-negative melanoma.
  • Histopathology, immunohistochemistry, and quantitative immunocytology using gp100 marker to determine DCC density (DCCD).
  • Comparative genomic hybridization of gp100-positive cells and multivariable survival analysis.

Main Results:

  • Increased DCCD was significantly associated with an elevated risk of melanoma-specific death (HR 1.81 per 10-fold increase).
  • Even minimal DCCD (≤3) increased melanoma mortality risk compared to DCCD=0 (HR 1.63).
  • DCCD emerged as a stronger predictor of death than traditional histopathology, with a model including thickness, DCCD, and ulceration outperforming current AJCC staging.

Conclusions:

  • Dissemination of cancer cells to SLNs is a quantitative risk factor for melanoma mortality.
  • A prognostic model incorporating DCCD, tumor thickness, and ulceration provides superior survival prediction.
  • Quantitative immunocytology may offer clinical utility if validated in independent studies.