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Related Experiment Video

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High Mitotic Rate Predicts Sentinel Lymph Node Involvement in Thin Melanomas.

Anna J Skochdopole1, Onur C Kutlu2, Kathryn E Engelhardt1

  • 1Department of Surgery, Medical University of South Carolina, Charleston, South Carolina.

The Journal of Surgical Research
|July 26, 2020
PubMed
Summary

A mitotic rate (MR) of 4 or higher is a significant indicator for sentinel lymph node (SLN) biopsy in thin melanoma patients. This finding aids in selecting patients for SLN biopsy to detect lymph node disease.

Keywords:
MelanomaMitotic rateSentinel lymph nodeSurvival analysis

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Area of Science:

  • Oncology
  • Dermatology
  • Pathology

Background:

  • Sentinel lymph node (SLN) biopsy indications for thin melanoma have evolved.
  • Accurate prediction of lymph node metastasis in thin melanoma is crucial for patient management.
  • Identifying specific pathologic features is key to refining SLN biopsy selection criteria.

Purpose of the Study:

  • To evaluate pathologic features of T1 melanoma that predict SLN positivity.
  • To identify a specific mitotic rate (MR) threshold most predictive of lymph node disease.
  • To assist physicians in selecting thin melanoma patients for SLN biopsy.

Main Methods:

  • Analysis of the Surveillance, Epidemiology, and End Results database (2010-2013).
  • Inclusion of trunk or extremity cutaneous melanoma patients (≤1 mm depth) who underwent SLN biopsy.
  • Evaluation of tumor depth, mitotic rate (MR), ulceration, and location; MR dichotomized to find optimal predictive cut points.
  • Multivariable logistic regression and Kaplan-Meier analyses for SLN positivity and overall survival (OS).

Main Results:

  • Mitotic rate (MR) (P < 0.001), tumor location (P = 0.017), and ulceration (P < 0.001) were significantly associated with SLN positivity.
  • An MR ≥ 4 was significant for SLN positivity (P = 0.049).
  • Mean OS was lower for patients with MR ≥ 4 (43.2 months) compared to MR < 4 (46.7 months) (P < 0.001).

Conclusions:

  • A mitotic rate (MR) of 4 or higher is a significant predictor of SLN positivity in thin melanomas, similar to ulceration.
  • MR ≥ 4 should be considered a key indication for SLN biopsy in patients with thin melanoma.
  • This finding helps refine patient selection for SLN biopsy, improving management of thin melanoma.