Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The use of sentinel lymph node biopsy for the T1 melanoma is controversial. Recent reports have demonstrated that certain T1 melanomas are at increased risk for early regional metastases and late recurrence when compared with all thin melanomas. The purpose of this study was to review the authors' experience with wide excision and sentinel lymph node biopsy for certain patients with T1 melanoma. A retrospective analysis of 34 patients with T1 melanoma was completed over a 3-year period. Indications for sentinel lymph node biopsy included a Breslow thickness of less than or equal to 1 mm a Clark level of III or IV tumor ulceration, or tumor regression. Twenty-four patients met these criteria (13 men and 11 women). Mean age was 47.6 years (range, 23-88 years). Mean tumor thickness for all patients was 0.69 mm (range, 0.3-1.0 mm), 0.61 mm for the Clark level III patients (N = 15), and 0.72 mm for the Clark level IV patients (N = 9). Tumor ulceration was present in 1 patient and histological regression was present in 2 patients. Regional lymph node metastases were confirmed histologically in 2 of 24 patients (8.3%) in whom the thickness of the melanoma was 0.9 mm and 1 mm. Both patients have died of metastatic melanoma. No recurrence has been demonstrated in the remaining 22 patients at the 2 to 5-year follow-up. Current indications for sentinel lymph node biopsy for patients with T1 melanoma include tumors associated with Clark level IV or V invasion, ulceration, regression, a positive deep margin on initial biopsy, or previous melanoma. Acral lentiginous melanoma associated with at least a Clark level III invasion warrant sentinel lymph node biopsy. Superficial spreading or nodular melanoma larger than 0.9 mm should include sentinel lymph node biopsy regardless of other associated histological factors.
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PMID:Sentinel lymph node biopsy for the T1 (thin) melanoma: is it necessary? 1278 9

Management of patients with cutaneous melanoma in the absence of lymph node metastases is still controversial. The experience at the National Cancer Institute in Naples was analyzed to evaluate 3-year disease-free survival and overall survival for all patients who underwent sentinel lymph node biopsy (SLB) with Breslow thickness greater than 4 mm. Data from 359 sentinel biopsies performed in the past 5 years were reviewed to determine the effect of the treatment on disease-free survival and overall survival after stratifying patients for node status, tumor ulceration, and Breslow thickness. Statistical analysis showed a better 3-year survival for sentinel node-negative patients than for sentinel node-positive cases (88.4% and 72.9%, respectively; P <.05). Tumor ulceration retained its prognostic significance despite lymph node status, indicating a higher risk for development of distant metastases. Survival curves associated with thicker melanomas did not show significant differences between negative- and positive-SLB patients. SLB provides accurate staging of nodal status in melanoma patients who have no clinical evidence of metastases. Longer follow-up and final results from ongoing trials are necessary to definitively clarify the role of this procedure.
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PMID:Sentinel lymph node biopsy does not change melanoma-specific survival among patients with Breslow thickness greater than four millimeters. 1502 51

The aim of the present study is to report our experience with lymphatic mapping (LM) and sentinel lymph node biopsy (SLNB) in a selected group of patients with thin primary cutaneous melanomas. Fifty patients (22 females and 28 males; mean age, 57.8 years; range, 30-77 years) with a mean tumor thickness of 0.63 mm (range, 0.24-1.00 mm) underwent LM/SLNB. Twenty-eight (56%) of them had Clark level II, 20 (40%) had Clark level III, and two (4%) had Clark level IV. Tumor ulceration was present in two patients (4%) and histological regression in 35 patients (70%). Sentinel lymph node (SLN) metastases occurred in two of 50 patients (4%). The first case was a 0.88-mm thick, Clark level III, non-ulcerated superficial spreading melanoma of the trunk, without any regression. The second case was a 0.95-mm thick, Clark level IV, non-ulcerated superficial spreading melanoma of the neck, with regression. Both patients were disease-free 76 and 50 months after the SLNB procedure and followed complete lymph node dissection, respectively. The patients with negative SLN were disease-free after a median follow up of 44 months (mean, 43.2; range, 15-84 months). Published data and our experience suggest that LM/SLNB is not routinely indicated for melanomas less than 0.75 mm. Our results confirmed the accuracy of the new American Joint Committee on Cancer/International Union Against Cancer criteria, in which SLNB is required for thin melanomas less than 1.0 mm when they have ulceration or Clark level IV and V invasion.
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PMID:Sentinel lymph node biopsy in patients with thin melanomas. 1768 80

Few studies have analysed the relationship between tumour regression and risk of nodal metastasis in patients with thin melanomas (Breslow thickness < or = 1 mm), and the conclusions reported have been conflicting. The aim of this study was to evaluate the role of histological regression as a predictor of lymph node metasta- sis in a selected group of patients with thin melanomas, submitted to lymphatic mapping and sentinel lymph node biopsy. From November 1999 to November 2006, 59 patients with thin melanomas (28 females and 31 males; mean age: 58.7 years) underwent lymphatic mapping and sentinel lymph node biopsy. The mean Breslow thickness was 0.60 mm (range: 0.24-1 mm). Tumour ulceration was present in 2 patients (3.4%) and histological regression in 45 (76.3%). Sentinel lymph node metastases were detected in 2 of 59 patients (3.4%), but only one patient with a positive sentinel lymph node exhibited histological regression of his tumour. Therefore, the sentinel lymph node positivity rate in thin regressing melanomas was 2.2%. Literature data and our experience suggest that tumour regression is not a predictor of sentinel lymph node metastasis in patients with thin melanomas, and therefore does not justify the routine use of lymphatic mapping and sentinel lymph node biopsy in this melanoma setting.
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PMID:Tumour regression does not increase the risk of sentinel node involvement in thin melanomas. 1868 75