Skip to main content
SpringerLink
Log in

Isolated Tumor Cells in the Sentinel Node Affect Long-Term Prognosis of Patients with Melanoma

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The clinical significance of isolated tumor cells (ITCs) in the melanoma-draining sentinel nodes (SNs) is unclear.

Methods

Records of patients who underwent SN biopsy (SNB) for stage I/II melanoma at our institute between 1991 and 2003 were reviewed to identify patients whose SNs were tumor-free or contained only ITC (≤0.2 mm). Tumor-positive SNs were reevaluated by the study pathologist to confirm the diagnosis and microstage the SN. Characteristics of the primary melanoma, tumor status of regional lymph nodes, and other prognostic variables were recorded. Melanoma-specific survival (MSS) rates were compared by the log-rank test.

Results

Of 1382 patients who underwent SNB, 1168 (85%) had tumor-free SNs; among the 214 remaining patients with tumor-positive SNs, 57 had metastases limited to ITC. Completion lymphadenectomy (CLND) was performed in 52 of 57 patients: six (12%) had metastases in nonsentinel nodes (NSNs). At a median follow-up of 57 months, 5-year and 10-year MSS was significantly higher (P = .02) for the 1168 patients with tumor-negative SNs (94 ± 1% and 87 ± 2%, respectively) than the 57 patients with ITC-positive SNs (89 ± 4% and 80 ± 7%, respectively). Multivariate analysis identified ITC (P = .002), Breslow’s thickness (P < .0001), ulceration (P < .0001), and primary site (P = .04) as significant for MSS.

Conclusion

Patients with ITC in SNs have a significantly higher risk of melanoma-specific death than those with tumor-negative SNs. The 12% incidence of nonsentinel node metastasis is similar to rates reported for patients with more extensive SN involvement. Patients with ITC should be considered for CLND.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

FIG. 1.
FIG. 2.
FIG. 3.

Similar content being viewed by others

References

  1. Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992; 127(4):392–9

    PubMed  CAS  Google Scholar 

  2. Giuliano AE, Kirgan DM, Guenther JM, Morton DL. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg 1994; 220(3):391–8

    Article  PubMed  CAS  Google Scholar 

  3. Chen SL, Iddings DM, Scheri RP, Bilchik AJ. Lymphatic mapping and sentinel node analysis: current concepts and applications. CA Cancer J Clin 2006; 56(5):292–9

    Article  PubMed  Google Scholar 

  4. Morton DL, Cochran AJ, Thompson JF, et al. Sentinel node biopsy for early-stage melanoma: accuracy and morbidity in MSLT-I, an international multicenter trial. Ann Surg 2005; 242(3):302–11

    PubMed  Google Scholar 

  5. Morton DL, Thompson JF, Cochran AJ, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med 2006; 355(13):1307–17

    Article  PubMed  CAS  Google Scholar 

  6. McMasters KM, Reintgen DS, Ross MI, et al. Sentinel lymph node biopsy for melanoma: controversy despite widespread agreement. J Clin Oncol 2001; 19(11):2851–5

    PubMed  CAS  Google Scholar 

  7. Elias N, Tanabe KK, Sober AJ, et al. Is completion lymphadenectomy after a positive sentinel lymph node biopsy for cutaneous melanoma always necessary? Arch Surg 2004; 139(4):400–4

    Article  PubMed  Google Scholar 

  8. Starz H, Balda BR, Kramer KU, et al. A micromorphometry-based concept for routine classification of sentinel lymph node metastases and its clinical relevance for patients with melanoma. Cancer 2001; 91(11):2110–21

    Article  PubMed  CAS  Google Scholar 

  9. Scolyer RA, Li LX, McCarthy SW, et al. Micromorphometric features of positive sentinel lymph nodes predict involvement of nonsentinel nodes in patients with melanoma. Am J Clin Pathol 2004; 122(4):532–9

    Article  PubMed  Google Scholar 

  10. Dewar DJ, Newell B, Green MA, et al. The microanatomic location of metastatic melanoma in sentinel lymph nodes predicts nonsentinel lymph node involvement. J Clin Oncol 2004; 22(16):3345–9

    Article  PubMed  CAS  Google Scholar 

  11. Lee JH, Essner R, Torisu-Itakura H, et al. Factors predictive of tumor-positive nonsentinel lymph nodes after tumor-positive sentinel lymph node dissection for melanoma. J Clin Oncol 2004; 22(18):3677–84

    Article  PubMed  Google Scholar 

  12. Sabel MS, Griffith K, Sondak VK, et al. Predictors of nonsentinel lymph node positivity in patients with a positive sentinel node for melanoma. J Am Coll Surg 2005; 201(1):37–47

    Article  PubMed  Google Scholar 

  13. Czerniecki BJ, Scheff AM, Callans LS, et al. Immunohistochemistry with pancytokeratins improves the sensitivity of sentinel lymph node biopsy in patients with breast carcinoma. Cancer 1999; 85(5):1098–103

    Article  PubMed  CAS  Google Scholar 

  14. van Akkooi AC, de Wilt JH, Verhoef C, et al. Clinical relevance of melanoma micrometastases (<0.1 mm) in sentinel nodes: are these nodes to be considered negative? Ann Oncol 2006; 17(10):1578–85

    Article  PubMed  Google Scholar 

  15. Govindarajan A, Ghazarian DM, McCready DR, Leong WL. Histological features of melanoma sentinel lymph node metastases associated with status of the completion lymphadenectomy and rate of subsequent relapse. Ann Surg Oncol 2007; 14(2):906–12

    Article  PubMed  Google Scholar 

  16. Morton DL, Thompson JF, Essner R, et al. Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: a multicenter trial. Multicenter Selective Lymphadenectomy Trial Group. Ann Surg 1999; 230(4):453–63

    Article  PubMed  CAS  Google Scholar 

  17. Cochran AJ, Wen DR, Morton DL. Occult tumor cells in the lymph nodes of patients with pathological stage I malignant melanoma. An immunohistological study. Am J Surg Pathol 1988; 12(8):612–8

    Article  PubMed  CAS  Google Scholar 

  18. Gershenwald JE, Thompson W, Mansfield PF, et al. Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients. J Clin Oncol 1999; 17(3):976–83

    PubMed  CAS  Google Scholar 

  19. Takeuchi H, Morton DL, Kuo C, et al. Prognostic significance of molecular upstaging of paraffin-embedded sentinel lymph nodes in melanoma patients. J Clin Oncol 2004; 22(13):2671–80

    Article  PubMed  CAS  Google Scholar 

  20. Kammula US, Ghossein R, Bhattacharya S, Coit DG. Serial follow-up and the prognostic significance of reverse transcriptase-polymerase chain reaction—staged sentinel lymph nodes from melanoma patients. J Clin Oncol 2004; 22(19):3989–96

    Article  PubMed  Google Scholar 

  21. Scoggins CR, Ross MI, Reintgen DS, et al. Prospective multi-institutional study of reverse transcriptase polymerase chain reaction for molecular staging of melanoma. J Clin Oncol 2006; 24(18):2849–57

    Article  PubMed  CAS  Google Scholar 

  22. Wong SL, Morton DL, Thompson JF, et al. Melanoma patients with positive sentinel nodes who did not undergo completion lymphadenectomy: a multi-institutional study. Ann Surg Oncol 2006; 13(6):809–16

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Supported by grant CA29605 from the National Cancer Institute and by funding from the Wayne and Gladys Valley Foundation (Oakland, CA), the Harold J. McAlister Charitable Foundation (Los Angeles, CA), the Wrather Family Foundation (Los Alamos, CA), the Family of Robert Novick (Los Angeles, CA), the Samueli Foundation (Corona del Mar, CA) and the Saban Family Foundation (Los Angeles, CA).

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, CA, USA

    Randall P. Scheri MD, Richard Essner MD & Donald L. Morton MD

  2. Department of Pathology, Saint John’s Health Center, Santa Monica, CA, USA

    Roderick R. Turner MD

  3. Biostatistical Unit, John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, CA, USA

    Xing Ye MS

Authors
  1. Randall P. Scheri MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Richard Essner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roderick R. Turner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xing Ye MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Donald L. Morton MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Richard Essner MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Scheri, R.P., Essner, R., Turner, R.R. et al. Isolated Tumor Cells in the Sentinel Node Affect Long-Term Prognosis of Patients with Melanoma. Ann Surg Oncol 14, 2861–2866 (2007). https://doi.org/10.1245/s10434-007-9472-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-007-9472-y

Keywords

Search

Navigation