Influence of Sentinel Lymph Node Tumor Burden on Survival in Melanoma

Completion lymph node dissection (CLND) is the standard procedure for patients with positive sentinel lymph nodes (SLN). With extensive pathological workup, increased numbers of small metastatic deposits are detected in SLN. This study evaluated the prognostic significance of SLN metastatic deposits a parts per thousand currency sign 0.2 mm in patients treated in a referral cancer center in Brazil. Patients with stage I/II melanoma, consecutively submitted to a SLN procedure by the same surgeon from 2000 to 2006, were evaluated. All positive SLN and randomly selected negative cases were reviewed by two pathologists. Different prognostic factors and SLN tumor burden were recorded. Additional positive non-SLN after CLND, and disease outcome were evaluated. Of 381 patients who underwent SLN biopsy, 103 (27%) were positive. The mean/median Breslow tumor thickness in the overall group was 3.4/2.0 mm and in the SLN positive patients was 5.72/4.0 mm. Among these patients, 48 (47%) had metastatic deposits > 2 mm (macrometastasis), 49 (47%) had metastatic deposits a parts per thousand currency sign2 mm but > 0.2 mm (micrometastasis), and 6 (6%) had metastatic deposits a parts per thousand currency sign0.2 mm (submicrometastasis). Additional positive non-SLN were detected in 29% of patients with macrometastasis, in 25% of patients with micrometastasis, and in 0% of patients with submicrometastases. At median follow-up of 35 months, the estimated 3-year overall survival was 92% for negative SLN, 64% for micrometastases, 53% for macrometastases, and 100% for submicrometastases (P < 0.001). In the present study, patients with SLN metastatic deposits a parts per thousand currency sign0.2 mm had no additional positive non-SLNs, and no recurrences or deaths were recorded, suggesting that their prognosis is equivalent to that of patients with negative SLN.