Long-term survival analysis and clinical follow-up in acral lentiginous malignant melanoma undergoing sentinel lymph node biopsy in korean patients

Abstract

Background: In cutaneous malignant melanoma (MM) with clinically uninvolved regional lymph nodes, sentinel lymph node (SLN) status is the most powerful indicator of both overall survival (OS) and disease-free survival (DFS). However, no studies on the long-term survival and clinical follow-up of Korean patients with acral lentiginous MM (ALM) undergoing SLN biopsy (SLNB) have been published.

Objective: The purpose of this study was to investigate the clinical prognosis and long-term survival of Korean patients with ALM according to SLN status.

Methods: Thirty-four ALM patients undergoing SLNB were included in this study. We evaluated clinical and histopathological follow-up data such as the stage of disease, treatment, recurrence, and metastasis, and analyzed OS and DFS according to SLN status.

Results: The median follow-up time was 60.5 months (range 3~127 months). Positive SLNs were noted in 14 patients (41.2%). Patients with negative SLNs had better OS and DFS than those with positive SLNs (p<0.05). Increased Breslow thickness was associated with short OS and DFS (p<0.05), and female patients showed better DFS than male patients (p<0.05).

Conclusion: To our knowledge, this is the first study on the long-term survival and clinical follow-up of patients undergoing SLNB for ALM in Korea. Our findings show that SLN status is an important prognostic factor for predicting OS and DFS.

Keywords: Acral lentiginous malignant melanoma; Prognosis; Sentinel lymph node biopsy; Survival.

Fig. 1

Lymphoscintigraphy-guided sentinel lymph node (SLN) biopsy. (A) Intradermal injection of radioactive tracer (technetium-99m) around the primary tumor. (B) The lymphoscintigram obtained from a patient with cutaneous melanoma on the right sole (primary tumor: red arrow, SLN: blue arrow). (C) Harvesting SLN(s) & measuring their radioactivity (SLN: black arrow). (D) Confirmation of the excised SLN(s) with significant high radioactivity.

Fig. 2

The Kaplan-Meier survival curves of patients with positive sentinel lymph nodes (SLNs) (solid line) and negative SLNs (dotted line). (A) Overall survival and (B) disease-free survival are shown.