By Marilynn Larkin
NEW YORK (Reuters Health) - Contrary to current guidelines, early melanoma patients under age 40 may be more suitable for sentinel lymph node biopsy (SLNB) than those over age 65, researchers in Pennsylvania suggest.
Guidelines for SLNB focus on pathologic factors, but patient factors such as age are generally not considered, according to Dr. Giorgos Karakousis of the University of Pennsylvania in Philadelphia and colleagues.
To investigate, the team analyzed data from 2010 to 2013 for 8,772 patients (about half, women) with stage 1 (0.50 to 1.0 mm) thin melanoma who underwent SLNB.
As reported online July 19 in JAMA Dermatology, 333 patients had nodal metastases, for an overall positivity rate of 3.8%. The median age was 52 for those with positive lymph nodes and 56 for those with negative nodes (P<0.001).
In multivariable analysis, younger age, female gender, lesion thickness of 0.76 mm or larger, increasing Clark level (level of skin invasion), mitoses, ulceration, and lymphovascular invasion all were independently associated with lymph node positivity.
A decision tree analysis identified patient age as an important risk stratifier for lymph node metastases, after mitoses and thickness. Patients under age 40 with category T1b tumors 0.50 mm to 0.75 mm, who normally would not be recommended for SLNB, had a lymph node positivity rate of 5.6%.
By contrast, patients 65 or older with T1b tumors 0.76 mm or larger, who usually would be recommended for SLNB, had a lymph node positivity rate of 3.9%.
Summing up, Dr. Karakousis told Reuters Health by email, “While generally the decision for SLNB in thin melanomas has been based on consideration of tumor factors such as thickness, ulceration and mitotic index, age may be an additional important patient factor which can predict likelihood of SLN metastases in those with these early lesions, which constitute the majority of newly diagnosed cases of melanoma.”
“An older patient, often with several medical comorbidities, may a have lower risk for nodal disease than a younger patient with a similar set of tumor characteristics, and this should perhaps be considered in the discussion with patients,” he said.
Editorialist Dr. Vernon Sondak of Moffitt Cancer Center in Tampa, Florida, told Reuters Health the study is “is important and provocative, but still fairly preliminary - it does not have the statistical power and has not been adequately validated to be considered practice-changing.”
“But it does illustrate that straightforward criteria like patient age could potentially help identify patients who should have a sentinel node biopsy but aren’t currently recommended to have one, or vice versa,” he said by email.
“The percentage of cases with a positive lymph node is just one aspect of the decision-making process for surgery,” he added. “The specific needs and desires of the patient and any possible health issues that would increase the risk of surgery must also be taken into proper consideration.”
SOURCE: https://bit.ly/2v8eGFr
JAMA Dermatol 2017.
(c) Copyright Thomson Reuters 2017. Click For Restrictions - https://about.reuters.com/fulllegal.asp
By Marilynn Larkin
NEW YORK (Reuters Health) - Contrary to current guidelines, early melanoma patients under age 40 may be more suitable for sentinel lymph node biopsy (SLNB) than those over age 65, researchers in Pennsylvania suggest.
Guidelines for SLNB focus on pathologic factors, but patient factors such as age are generally not considered, according to Dr. Giorgos Karakousis of the University of Pennsylvania in Philadelphia and colleagues.
To investigate, the team analyzed data from 2010 to 2013 for 8,772 patients (about half, women) with stage 1 (0.50 to 1.0 mm) thin melanoma who underwent SLNB.
As reported online July 19 in JAMA Dermatology, 333 patients had nodal metastases, for an overall positivity rate of 3.8%. The median age was 52 for those with positive lymph nodes and 56 for those with negative nodes (P<0.001).
In multivariable analysis, younger age, female gender, lesion thickness of 0.76 mm or larger, increasing Clark level (level of skin invasion), mitoses, ulceration, and lymphovascular invasion all were independently associated with lymph node positivity.
A decision tree analysis identified patient age as an important risk stratifier for lymph node metastases, after mitoses and thickness. Patients under age 40 with category T1b tumors 0.50 mm to 0.75 mm, who normally would not be recommended for SLNB, had a lymph node positivity rate of 5.6%.
By contrast, patients 65 or older with T1b tumors 0.76 mm or larger, who usually would be recommended for SLNB, had a lymph node positivity rate of 3.9%.
Summing up, Dr. Karakousis told Reuters Health by email, “While generally the decision for SLNB in thin melanomas has been based on consideration of tumor factors such as thickness, ulceration and mitotic index, age may be an additional important patient factor which can predict likelihood of SLN metastases in those with these early lesions, which constitute the majority of newly diagnosed cases of melanoma.”
“An older patient, often with several medical comorbidities, may a have lower risk for nodal disease than a younger patient with a similar set of tumor characteristics, and this should perhaps be considered in the discussion with patients,” he said.
Editorialist Dr. Vernon Sondak of Moffitt Cancer Center in Tampa, Florida, told Reuters Health the study is “is important and provocative, but still fairly preliminary - it does not have the statistical power and has not been adequately validated to be considered practice-changing.”
“But it does illustrate that straightforward criteria like patient age could potentially help identify patients who should have a sentinel node biopsy but aren’t currently recommended to have one, or vice versa,” he said by email.
“The percentage of cases with a positive lymph node is just one aspect of the decision-making process for surgery,” he added. “The specific needs and desires of the patient and any possible health issues that would increase the risk of surgery must also be taken into proper consideration.”
SOURCE: https://bit.ly/2v8eGFr
JAMA Dermatol 2017.
(c) Copyright Thomson Reuters 2017. Click For Restrictions - https://about.reuters.com/fulllegal.asp
By Marilynn Larkin
NEW YORK (Reuters Health) - Contrary to current guidelines, early melanoma patients under age 40 may be more suitable for sentinel lymph node biopsy (SLNB) than those over age 65, researchers in Pennsylvania suggest.
Guidelines for SLNB focus on pathologic factors, but patient factors such as age are generally not considered, according to Dr. Giorgos Karakousis of the University of Pennsylvania in Philadelphia and colleagues.
To investigate, the team analyzed data from 2010 to 2013 for 8,772 patients (about half, women) with stage 1 (0.50 to 1.0 mm) thin melanoma who underwent SLNB.
As reported online July 19 in JAMA Dermatology, 333 patients had nodal metastases, for an overall positivity rate of 3.8%. The median age was 52 for those with positive lymph nodes and 56 for those with negative nodes (P<0.001).
In multivariable analysis, younger age, female gender, lesion thickness of 0.76 mm or larger, increasing Clark level (level of skin invasion), mitoses, ulceration, and lymphovascular invasion all were independently associated with lymph node positivity.
A decision tree analysis identified patient age as an important risk stratifier for lymph node metastases, after mitoses and thickness. Patients under age 40 with category T1b tumors 0.50 mm to 0.75 mm, who normally would not be recommended for SLNB, had a lymph node positivity rate of 5.6%.
By contrast, patients 65 or older with T1b tumors 0.76 mm or larger, who usually would be recommended for SLNB, had a lymph node positivity rate of 3.9%.
Summing up, Dr. Karakousis told Reuters Health by email, “While generally the decision for SLNB in thin melanomas has been based on consideration of tumor factors such as thickness, ulceration and mitotic index, age may be an additional important patient factor which can predict likelihood of SLN metastases in those with these early lesions, which constitute the majority of newly diagnosed cases of melanoma.”
“An older patient, often with several medical comorbidities, may a have lower risk for nodal disease than a younger patient with a similar set of tumor characteristics, and this should perhaps be considered in the discussion with patients,” he said.
Editorialist Dr. Vernon Sondak of Moffitt Cancer Center in Tampa, Florida, told Reuters Health the study is “is important and provocative, but still fairly preliminary - it does not have the statistical power and has not been adequately validated to be considered practice-changing.”
“But it does illustrate that straightforward criteria like patient age could potentially help identify patients who should have a sentinel node biopsy but aren’t currently recommended to have one, or vice versa,” he said by email.
“The percentage of cases with a positive lymph node is just one aspect of the decision-making process for surgery,” he added. “The specific needs and desires of the patient and any possible health issues that would increase the risk of surgery must also be taken into proper consideration.”
SOURCE: https://bit.ly/2v8eGFr
JAMA Dermatol 2017.
(c) Copyright Thomson Reuters 2017. Click For Restrictions - https://about.reuters.com/fulllegal.asp
