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01.09.2013 | Melanomas

Is Head and Neck Melanoma Different from Trunk and Extremity Melanomas with Respect to Sentinel Lymph Node Status and Clinical Outcome?

verfasst von: Niloofar Fadaki, MD, Rui Li, PhD, Brian Parrett, MD, Grant Sanders, MD, Suresh Thummala, MD, Lea Martineau, RN, Servando Cardona-Huerta, MD, PhD, Suzette Miranda, MD, Shih-Tsung Cheng, MD, James R. Miller III, PhD, Mark Singer, MD, James E. Cleaver, PhD, Mohammed Kashani-Sabet, MD, Stanley P. L. Leong, MD, FACS

Erschienen in: Annals of Surgical Oncology | Ausgabe 9/2013

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Abstract

Background

Previous studies showed conflicting and inconsistent results regarding the effect of anatomic location of the melanoma on sentinel lymph node (SLN) positivity and/or survival. This study was conducted to evaluate and compare the effect of the anatomic locations of primary melanoma on long-term clinical outcomes.

Methods

All consecutive cutaneous melanoma patients (n = 2,079) who underwent selective SLN dissection (SLND) from 1993 to 2009 in a single academic tertiary-care medical center were included. SLN positive rate, disease-free survival (DFS), and overall survival (OS) were determined. Kaplan-Meier survival, univariate, and multivariate analyses were performed to determine predictive factors for SLN status, DFS, and OS.

Results

Head and neck melanoma (HNM) had the lowest SLN-positive rate at 10.8 % (16.8 % for extremity and 19.3 % for trunk; P = 0.002) but had the worst 5-year DFS (P < 0.0001) and 5-year OS (P < 0.0001) compared with other sites. Tumor thickness (P < 0.001), ulceration (P < 0.001), HNM location (P = 0.001), mitotic rate (P < 0.001), and decreasing age (P < 0.001) were independent predictive factors for SLN-positivity. HNM with T3 or T4 thickness had significantly lower SLN positive rate compared with other locations (P ≤ 0.05). Also, on multivariate analysis, HNM location versus other anatomic sites was independently predictive of decreased DFS and OS (P < 0.001). By Kaplan-Meier analysis, HNM was associated significantly with the worst DFS and OS.

Conclusions

Primary melanoma anatomic location is an independent predictor of SLN status and survival. Although HNM has a decreased SLN-positivity rate, it shows a significantly increased risk of recurrence and death as compared with other sites.

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.PubMedCrossRef

Mays MP, Martin RC, Burton A, et al. Should all patients with melanoma between 1 and 2 mm Breslow thickness undergo sentinel lymph node biopsy? Cancer. 2010;116(6):1535–44.PubMedCrossRef

McMasters KM, Wong SL, Edwards MJ, et al. Factors that predict the presence of sentinel lymph node metastasis in patients with melanoma. Surgery. 2001;130(2):151–6.PubMedCrossRef

Niakosari F, Kahn HJ, McCready D, et al. Lymphatic invasion identified by monoclonal antibody D2-40, younger age, and ulceration: predictors of sentinel lymph node involvement in primary cutaneous melanoma. Arch Dermatol. 2008;144(4):462–7.PubMedCrossRef

Paek SC, Griffith KA, Johnson TM, et al. The impact of factors beyond Breslow depth on predicting sentinel lymph node positivity in melanoma. Cancer. 2007;109(1):100–8.PubMedCrossRef

Rousseau DL, Jr., Ross MI, Johnson MM, et al. Revised American Joint Committee on Cancer staging criteria accurately predict sentinel lymph node positivity in clinically node-negative melanoma patients. Ann Surg Oncol. 2003;10(5):569–74.PubMedCrossRef

Sondak VK, Taylor JM, Sabel MS, et al. Mitotic rate and younger age are predictors of sentinel lymph node positivity: lessons learned from the generation of a probabilistic model. Ann Surg Oncol. 2004;11(3):247–58.PubMedCrossRef

White RL Jr, Ayers GD, Stell VH, et al. Factors predictive of the status of sentinel lymph nodes in melanoma patients from a large multicenter database. Ann Surg Oncol. 2011;18(13):3593–600.PubMedCrossRef

Chao C, Martin RC 2nd, Ross MI, et al. Correlation between prognostic factors and increasing age in melanoma. Ann Surg Oncol. 2004;11(3):259–64.PubMedCrossRef

10.

Sassen S, Shaw HM, Colman MH, Scolyer RA, Thompson JF. The complex relationships between sentinel node positivity, patient age, and primary tumor desmoplasia: analysis of 2303 melanoma patients treated at a single center. Ann Surg Oncol. 2008;15(2):630–7.PubMedCrossRef

11.

McMasters KM, Noyes RD, Reintgen DS, et al. Lessons learned from the Sunbelt Melanoma Trial. J Surg Oncol. 2004;86(4):212–23.PubMedCrossRef

12.

Cadili A, Dabbs K. Predictors of sentinel lymph node metastasis in melanoma. Can J Surg. 2010;53(1):32–6.PubMed

13.

Cascinelli N, Bombardieri E, Bufalino R, et al. Sentinel and nonsentinel node status in stage IB and II melanoma patients: two-step prognostic indicators of survival. J Clin Oncol. 2006;24(27):4464–71.PubMedCrossRef

14.

Kretschmer L, Starz H, Thoms KM, et al. Age as a key factor influencing metastasizing patterns and disease-specific survival after sentinel lymph node biopsy for cutaneous melanoma. Int J Cancer. 2011;129(6):1435–42.PubMedCrossRef

15.

Kruper LL, Spitz FR, Czerniecki BJ, et al. Predicting sentinel node status in AJCC stage I/II primary cutaneous melanoma. Cancer. 2006;107(10):2436–45.PubMedCrossRef

16.

Kunte C, Geimer T, Baumert J, et al. Prognostic factors associated with sentinel lymph node positivity and effect of sentinel status on survival: an analysis of 1049 patients with cutaneous melanoma. Melanoma Res. 2010;20(4):330–7.PubMedCrossRef

17.

Mandala M, Imberti GL, Piazzalunga D, et al. Clinical and histopathological risk factors to predict sentinel lymph node positivity, disease-free and overall survival in clinical stages I-II AJCC skin melanoma: outcome analysis from a single-institution prospectively collected database. Eur J Cancer. 2009;45(14):2537–45.PubMedCrossRef

18.

Mraz-Gernhard S, Sagebiel RW, Kashani-Sabet M, Miller JR, 3rd, Leong SP. Prediction of sentinel lymph node micrometastasis by histological features in primary cutaneous malignant melanoma. Arch Dermatol. 1998;134(8):983–7.PubMedCrossRef

19.

Taylor RC, Patel A, Panageas KS, Busam KJ, Brady MS. Tumor-infiltrating lymphocytes predict sentinel lymph node positivity in patients with cutaneous melanoma. J Clin Oncol. 2007;25(7):869–75.PubMedCrossRef

20.

Wagner JD, Gordon MS, Chuang TY, et al. Predicting sentinel and residual lymph node basin disease after sentinel lymph node biopsy for melanoma. Cancer. 2000;89(2):453–62.PubMedCrossRef

21.

Ellis MC, Weerasinghe R, Corless CL, Vetto JT. Sentinel lymph node staging of cutaneous melanoma: predictors and outcomes. Am J Surg. 2010;199(5):663–8.PubMedCrossRef

22.

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

23.

Mitra A, Conway C, Walker C, et al. Melanoma sentinel node biopsy and prediction models for relapse and overall survival. Br J Cancer. 2010;103(8):1229–36.PubMedCrossRef

24.

Sartore L, Papanikolaou GE, Biancari F, Mazzoleni F. Prognostic factors of cutaneous melanoma in relation to metastasis at the sentinel lymph node: a case-controlled study. Int J Surg. 2008;6(3):205–9.PubMedCrossRef

25.

Gillgren P, Brattstrom G, Frisell J, Persson JO, Ringborg U, Hansson J. Effect of primary site on prognosis in patients with cutaneous malignant melanoma. A study using a new model to analyse anatomical locations. Melanoma Res. 2005;15(2):125–32.PubMedCrossRef

26.

Lindholm C, Andersson R, Dufmats M, et al. Invasive cutaneous malignant melanoma in Sweden, 1990–1999. A prospective, population-based study of survival and prognostic factors. Cancer. 2004;101(9):2067–78.PubMedCrossRef

27.

Homsi J, Kashani-Sabet M, Messina JL, Daud A. Cutaneous melanoma: prognostic factors. Cancer Control. 2005;12(4):223–9.PubMed

28.

Yee VS, Thompson JF, McKinnon JG, et al. Outcome in 846 cutaneous melanoma patients from a single center after a negative sentinel node biopsy. Ann Surg Oncol. 2005;12(6):429–39.PubMedCrossRef

29.

Kesmodel SB, Karakousis GC, Botbyl JD, et al. Mitotic rate as a predictor of sentinel lymph node positivity in patients with thin melanomas. Ann Surg Oncol. 2005;12(6):449–58.PubMedCrossRef

30.

Scoggins CR, Bowen AL, Martin RC 2nd, et al. Prognostic information from sentinel lymph node biopsy in patients with thick melanoma. Arch Surg. 2010;145(7):622–7.PubMedCrossRef

31.

Kashani-Sabet M, Sagebiel RW, Ferreira CM, Nosrati M, Miller JR 3rd. Vascular involvement in the prognosis of primary cutaneous melanoma. Arch Dermatol. 2001;137(9):1169–73.PubMedCrossRef

32.

Wagner JD, Ranieri J, Evdokimow DZ, et al. Patterns of initial recurrence and prognosis after sentinel lymph node biopsy and selective lymphadenectomy for melanoma. Plast Reconstr Surg. 2003;112(2):486–97.PubMedCrossRef

33.

Masback A, Olsson H, Westerdahl J, Ingvar C, Jonsson N. Prognostic factors in invasive cutaneous malignant melanoma: a population-based study and review. Melanoma Res. 2001;11(5):435–45.PubMedCrossRef

34.

Garbe C, Buttner P, Bertz J, et al. Primary cutaneous melanoma. Prognostic classification of anatomic location. Cancer. 1995;75(10):2492–8.PubMedCrossRef

35.

O’Brien CJ, Coates AS, Petersen-Schaefer K, et al. Experience with 998 cutaneous melanomas of the head and neck over 30 years. Am J Surg. 1991;162(4):310–4.PubMedCrossRef

36.

Ringborg U, Afzelius LE, Lagerlof B, et al. Cutaneous malignant melanoma of the head and neck. Analysis of treatment results and prognostic factors in 581 patients: a report from the Swedish Melanoma Study Group. Cancer. 1993;71(3):751–8.PubMedCrossRef

37.

Tseng WH, Martinez SR. Tumor location predicts survival in cutaneous head and neck melanoma. J Surg Res. 2011;167(2):192–8.PubMedCrossRef

38.

Wanebo HJ, Cooper PH, Young DV, Harpole DH, Kaiser DL. Prognostic factors in head and neck melanoma. Effect of lesion location. Cancer. 1988;62(4):831–7.PubMedCrossRef

39.

Leong SP, Accortt NA, Essner R, et al. Impact of sentinel node status and other risk factors on the clinical outcome of head and neck melanoma patients. Arch Otolaryngol Head Neck Surg. 2006;132(4):370–3.PubMedCrossRef

40.

Ballantyne AJ. Malignant melanoma of the skin of the head and neck. An analysis of 405 cases. Am J Surg. 1970;120(4):425–31.PubMedCrossRef

41.

Gillgren P, Mansson-Brahme E, Frisell J, Johansson H, Larsson O, Ringborg U. Epidemiological characteristics of cutaneous malignant melanoma of the head and neck–a population-based study. Acta Oncol. 1999;38(8):1069–74.PubMedCrossRef

42.

Loree TR, Spiro RH. Cutaneous melanoma of the head and neck. Am J Surg. 1989;158(4):388–91.PubMedCrossRef

43.

Balch CM, Soong SJ, Gershenwald JE, et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol. 2001;19(16):3622–34.PubMed

44.

Balch CM, Gershenwald JE, Soong SJ, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27(36):6199–206.PubMedCrossRef

45.

Balch CM, Buzaid AC, Atkins MB, et al. A new American Joint Committee on cancer staging system for cutaneous melanoma. Cancer. 2000;88(6):1484–91.PubMedCrossRef

46.

Fleming ID. AJCC cancer staging manual. 5th ed. Philadelphia: Lippincott-Raven; 1997.

47.

Leong SP. Sentinel lymph node mapping and selective lymphadenectomy: the standard of care for melanoma. Curr Treat Options Oncol. 2004;5(3):185–94.PubMedCrossRef

48.

Liu LC, Parrett BM, Jenkins T, et al. Selective sentinel lymph node dissection for melanoma: importance of harvesting nodes with lower radioactive counts without the need for Blue dye. Ann Surg Oncol. 2011;18(10):2919–24.PubMedCrossRef

49.

Treseler PA, Tauchi PS. Pathologic analysis of the sentinel lymph node. Surg Clin North Am. 2000;80(6):1695–719.PubMedCrossRef

50.

Caracò C, Marone U, Celentano E, Botti G, Mozzillo N. Impact of false-negative sentinel lymph node biopsy on survival in patients with cutaneous melanoma. Ann Surg Oncol. 2007;14(9):2662–7.PubMedCrossRef

51.

Panasiti V, Devirgiliis V, Curzio M, et al. Predictive factors for false negative sentinel lymph node in melanoma patients. Dermatol Surg. 2010;36(10):1521–8.PubMedCrossRef

52.

Erman AB, Collar RM, Griffith KA, et al. Sentinel lymph node biopsy is accurate and prognostic in head and neck melanoma. Cancer. 2012;118(4):1040–7.PubMedCrossRef

53.

Parrett BM, Kashani-Sabet M, Singer MI, et al. Long-term prognosis and significance of the sentinel lymph node in head and neck melanoma. Otolaryngol Head Neck Surg. 2012;147(4):699–706.PubMedCrossRef

54.

Day CL, Jr., Sober AJ, Kopf AW, et al. A prognostic model for clinical stage I melanoma of the trunk. Location near the midline is not an independent risk factor for recurrent disease. Am J Surg. 1981;142(2):247–51.PubMedCrossRef

55.

Day CL Jr, Sober AJ, Kopf AW, et al. A prognostic model for clinical stage I melanoma of the upper extremity. The importance of anatomic subsites in predicting recurrent disease. Ann Surg. 1981;193(4):436–40.PubMedCrossRef

56.

Rogers GS, Kopf AW, Rigel DS, et al. Influence of anatomic location on prognosis of malignant melanoma: attempt to verify the BANS model. J Am Acad Dermatol. 1986;15(2 Pt 1):231–7.PubMedCrossRef

57.

Woods JE, Taylor WF, Pritchard DJ, Sim FH, Ivins JC, Bergstralh EJ. Is the BANS concept for malignant melanoma valid? Am J Surg. 1985;150(4):452–5.

58.

Cascinelli N, Vaglini M, Bufalino R, Morabito A. BANS. A cutaneous region with no prognostic significance in patients with melanoma. Cancer. 1986;57(3):441–4.PubMedCrossRef

59.

Carlson GW, Murray DR, Lyles RH, Hestley A, Cohen C. Sentinel lymph node biopsy in the management of cutaneous head and neck melanoma. Plast Reconstr Surg. 2005;115(3):721–8.PubMedCrossRef

60.

Leong SP. Role of selective sentinel lymph node dissection in head and neck melanoma. J Surg Oncol. 2011;104(4):361–8.PubMed

61.

Pan WR, Le Roux CM, Briggs CA. Variations in the lymphatic drainage pattern of the head and neck: further anatomic studies and clinical implications. Plast Reconstr Surg. 2011;127(2):611–20.PubMedCrossRef

62.

Miller MW, Vetto JT, Monroe MM, Weerasinghe R, Andersen PE, Gross ND. False-negative sentinel lymph node biopsy in head and neck melanoma. Otolaryngol Head Neck Surg. 2011;145(4):606–11.PubMedCrossRef

63.

Saltman BE, Ganly I, Patel SG, et al. Prognostic implication of sentinel lymph node biopsy in cutaneous head and neck melanoma. Head Neck. 2010;32(12):1686–92.PubMedCrossRef

64.

Tanis PJ, Nieweg OE, van den Brekel MW, Balm AJ. Dilemma of clinically node-negative head and neck melanoma: outcome of “watch and wait” policy, elective lymph node dissection, and sentinel node biopsy–a systematic review. Head Neck. 2008;30(3):380–9.PubMedCrossRef

65.

McDonald K, Page AJ, Jordan SW, et al. Analysis of regional recurrence after negative sentinel lymph node biopsy for head and neck melanoma. Head Neck. 2013;35(5):667–71.PubMedCrossRef

66.

Testori A, De Salvo GL, Montesco MC, et al. Clinical considerations on sentinel node biopsy in melanoma from an Italian multicentric study on 1,313 patients (SOLISM-IMI). Ann Surg Oncol. 2009;16(7):2018–27.PubMedCrossRef

67.

Carlson GW, Page AJ, Cohen C, et al. Regional recurrence after negative sentinel lymph node biopsy for melanoma. Ann Surg. 2008;248(3):378–86.PubMed

68.

Callender GG, Egger ME, Burton AL, et al. Prognostic implications of anatomic location of primary cutaneous melanoma of 1 mm or thicker. Am J Surg. 2011;202(6):659–64; discussion 664–55.

69.

Hoersch B, Leiter U, Garbe C. Is head and neck melanoma a distinct entity? A clinical registry-based comparative study in 5702 patients with melanoma. Br J Dermatol. 2006;155(4):771–7.PubMedCrossRef

70.

Lachiewicz AM, Berwick M, Wiggins CL, Thomas NE. Survival differences between patients with scalp or neck melanoma and those with melanoma of other sites in the Surveillance, Epidemiology, and End Results (SEER) program. Arch Dermatol. 2008;144(4):515–21.PubMedCrossRef

Titel: Is Head and Neck Melanoma Different from Trunk and Extremity Melanomas with Respect to Sentinel Lymph Node Status and Clinical Outcome?
verfasst von: Niloofar Fadaki, MD
Rui Li, PhD
Brian Parrett, MD
Grant Sanders, MD
Suresh Thummala, MD
Lea Martineau, RN
Servando Cardona-Huerta, MD, PhD
Suzette Miranda, MD
Shih-Tsung Cheng, MD
James R. Miller III, PhD
Mark Singer, MD
James E. Cleaver, PhD
Mohammed Kashani-Sabet, MD
Stanley P. L. Leong, MD, FACS
Publikationsdatum: 01.09.2013
Verlag: Springer US
Erschienen in: Annals of Surgical Oncology / Ausgabe 9/2013
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-013-2977-7

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