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| |  Sentinel Lymph-Node Status Strongly Predicts Survival in Patients With Stage T4 Melanoma: Presented at SSO By Gabe Waggoner PHOENIX, Ariz -- March 10, 2009 -- Biopsy of the sentinel lymph node can benefit patients with thick and clinically node-negative disease, according to researchers presenting here at the Society of Surgical Oncology (SSO) 62nd Annual Cancer Symposium. Csaba Gajdos, MD, University of Michigan, Ann Arbor, Michigan, and colleagues sought to determine whether patients with melanoma classified by American Joint Committee on Cancer as stage T4 truly need sentinel lymph-node biopsy. After reviewing the database records of 293 T4-stage melanoma patients who had undergone surgery between 1998 and 2007, the researchers recorded patient demographics, histologic features, and outcomes. The team used statistical analyses to find a correlation with a having positive sentinel lymph node, and, ultimately, they created a multivariate analysis for survival that was free of distant disease. Their findings were presented during a poster session here on March 6. Of the initial cohort, 227 patients underwent biopsy of the sentinel lymph node; almost half of these patients (107) were positive for disease. The authors found that angiolymphatic invasion, satellitosis, and primary tumour ulceration strongly predicted sentinel lymph-node positivity. Disease recurred locoregionally in 11% of patients after a negative sentinel lymph node was determined, in 34% with a positive sentinel lymph node and complete lymph-node dissection, and in 21% with negative lymph nodes and no sentinel lymph node. Eighty-five percent of patients without sentinel lymph nodes survived 5 years without distant disease, Dr. Gajdos stated, whereas the corresponding survival rate for patients who had sentinel lymph nodes was 42.9%. Angiolymphatic invasion, ulceration of the tumour, and having at least 1 positive sentinel lymph node were statistically significant predictors of distant disease-free survival. "Sentinel lymph-node status was the most significant predictor of both distant disease-free survival and overall survival among patients with T4 melanoma, and ulceration was highly significant among the sentinel lymph node-negative patients," Dr. Gajdos said. Breslow depth (thickness) of the melanomas did not correlate statistically with a positive sentinel lymph node or with distant disease-free survival for stage T4 melanomas. Clinically node-negative T4 melanoma cases should be considered for sentinel lymph-node biopsy, Dr. Gajdos emphasised, no matter the Breslow depth of disease. He also pointed out that status of the sentinel lymph node was "the most significant prognostic sign among these patients for adjuvant therapy decisions." Dr. Gajdos emphasised that biopsy and complete dissection of the sentinel lymph node provide improved regional control. "Sentinel lymph-node biopsy should be the standard method of not only staging patients with thick melanoma but also guiding adjuvant therapy decisions," Dr. Gajdos concluded. "With adequate surgical therapy, T4 patients with a negative sentinel lymph node and no ulceration have an extremely low rate of distant recurrence and excellent overall survival." [Presentation title: Is There a Benefit to Sentinel Lymph Node (SLN) Biopsy in Patients With T4 Melanoma? Abstract 233]
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