Relationship between age and likelihood of lymph node metastases in patients with intermediate thickness melanoma (1.01-4.00 mm): A National Cancer Database study

Andrew N. Hanna, Andrew J. Sinnamon, Robert E. Roses, Rachel R. Kelz, David E. Elder, Xiaowei Xu, Barbara A Pockaj, Jonathan S. Zager, Douglas L. Fraker, Giorgos C. Karakousis

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: There is large variability in the risk of sentinel lymph node (SLN) positivity among patients with intermediate thickness melanoma (ITM), with a subgroup of patients exhibiting a low risk of nodal disease. Objective: To identify a group of patients with ITM for whom the risk of nodal disease is low. Methods: A retrospective cohort of patients with ITM who underwent wide excision and nodal evaluation from 2010 to 2013 was identified by using the National Cancer Database and analyzed for the presence of nodal disease. Classification and regression tree analysis identified the most important factors used in a model to identify groups at low risk of SLN positivity. Results: Of 23,440 patients, 14.7% were found to have nodal metastasis. On classification and regression tree analysis, patients older than 55 years without lymphovascular invasion and with a lesion thickness less than 1.7 mm had an SLN positivity rate of 4.9%. A model using age and thickness in nonulcerated patients identified a low-risk subgroup with a corresponding SLN positivity rate of 4.7%. Limitations: This was a retrospective study, and the model developed requires prospective validation. Conclusions: Patient age is an important factor in estimating risk of SLN in patients with ITM and may help identify patients without ulceration who may be safely spared an SLN biopsy.

Original languageEnglish (US)
JournalJournal of the American Academy of Dermatology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Melanoma
Lymph Nodes
Databases
Neoplasm Metastasis
Neoplasms
Regression Analysis
Sentinel Lymph Node Biopsy
Retrospective Studies
Sentinel Lymph Node

Keywords

  • age
  • intermediate thickness
  • melanoma
  • risk
  • sentinel lymph node

ASJC Scopus subject areas

  • Dermatology

Cite this

Relationship between age and likelihood of lymph node metastases in patients with intermediate thickness melanoma (1.01-4.00 mm) : A National Cancer Database study. / Hanna, Andrew N.; Sinnamon, Andrew J.; Roses, Robert E.; Kelz, Rachel R.; Elder, David E.; Xu, Xiaowei; Pockaj, Barbara A; Zager, Jonathan S.; Fraker, Douglas L.; Karakousis, Giorgos C.

In: Journal of the American Academy of Dermatology, 01.01.2018.

Research output: Contribution to journalArticle

Hanna, Andrew N. ; Sinnamon, Andrew J. ; Roses, Robert E. ; Kelz, Rachel R. ; Elder, David E. ; Xu, Xiaowei ; Pockaj, Barbara A ; Zager, Jonathan S. ; Fraker, Douglas L. ; Karakousis, Giorgos C. / Relationship between age and likelihood of lymph node metastases in patients with intermediate thickness melanoma (1.01-4.00 mm) : A National Cancer Database study. In: Journal of the American Academy of Dermatology. 2018.
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abstract = "Background: There is large variability in the risk of sentinel lymph node (SLN) positivity among patients with intermediate thickness melanoma (ITM), with a subgroup of patients exhibiting a low risk of nodal disease. Objective: To identify a group of patients with ITM for whom the risk of nodal disease is low. Methods: A retrospective cohort of patients with ITM who underwent wide excision and nodal evaluation from 2010 to 2013 was identified by using the National Cancer Database and analyzed for the presence of nodal disease. Classification and regression tree analysis identified the most important factors used in a model to identify groups at low risk of SLN positivity. Results: Of 23,440 patients, 14.7{\%} were found to have nodal metastasis. On classification and regression tree analysis, patients older than 55 years without lymphovascular invasion and with a lesion thickness less than 1.7 mm had an SLN positivity rate of 4.9{\%}. A model using age and thickness in nonulcerated patients identified a low-risk subgroup with a corresponding SLN positivity rate of 4.7{\%}. Limitations: This was a retrospective study, and the model developed requires prospective validation. Conclusions: Patient age is an important factor in estimating risk of SLN in patients with ITM and may help identify patients without ulceration who may be safely spared an SLN biopsy.",
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AU - Roses, Robert E.

AU - Kelz, Rachel R.

AU - Elder, David E.

AU - Xu, Xiaowei

AU - Pockaj, Barbara A

AU - Zager, Jonathan S.

AU - Fraker, Douglas L.

AU - Karakousis, Giorgos C.

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AB - Background: There is large variability in the risk of sentinel lymph node (SLN) positivity among patients with intermediate thickness melanoma (ITM), with a subgroup of patients exhibiting a low risk of nodal disease. Objective: To identify a group of patients with ITM for whom the risk of nodal disease is low. Methods: A retrospective cohort of patients with ITM who underwent wide excision and nodal evaluation from 2010 to 2013 was identified by using the National Cancer Database and analyzed for the presence of nodal disease. Classification and regression tree analysis identified the most important factors used in a model to identify groups at low risk of SLN positivity. Results: Of 23,440 patients, 14.7% were found to have nodal metastasis. On classification and regression tree analysis, patients older than 55 years without lymphovascular invasion and with a lesion thickness less than 1.7 mm had an SLN positivity rate of 4.9%. A model using age and thickness in nonulcerated patients identified a low-risk subgroup with a corresponding SLN positivity rate of 4.7%. Limitations: This was a retrospective study, and the model developed requires prospective validation. Conclusions: Patient age is an important factor in estimating risk of SLN in patients with ITM and may help identify patients without ulceration who may be safely spared an SLN biopsy.

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