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. 2023 Jan 1;86(1):72-79.
doi: 10.1097/JCMA.0000000000000809. Epub 2022 Sep 9.

Influencing factors associated with lymph node status in patients with cutaneous melanoma: An Asian population study

Po-Yu Chu  1 , Yi-Fan Chen  2   3 , Cheng-Yuan Li  4   5 , Tien-Hsiang Wang  1   6 , Yu-Jen Chiu  1   6   7 , Hsu Ma  1   6   8
Affiliations

Influencing factors associated with lymph node status in patients with cutaneous melanoma: An Asian population study

Po-Yu Chu et al. J Chin Med Assoc. .

Abstract

Background: Sentinel lymph node (SLN) status is the predominant prognostic factor in patients diagnosed with clinically localized melanoma. The significance of completion lymph node dissection in patients with SLN metastasis is debatable. Not many studies have been conducted on acrallentiginous melanoma (ALM). This study aimed to characterize the prognostic factors of nodal positive ALM and confirm whether ALM patients can undergo the same treatment strategy as non-ALM patients in the Asian population.

Methods: This is a retrospective review of patients who underwent surgery for cutaneous melanoma (CM) at Taipei Veterans General Hospital between January 1993 and December 2019. We investigated the risk factors for lymph node status. The association between clinicopathological factors and lymph node status of ALM and non-ALM patients was analyzed. Outcomes of completion lymph node dissection (CLND) performed following sentinel lymph node biopsy (SLNB) in the CM and ALM groups were compared.

Results: A total of 197 patients were included in this study. ALM was the most common histological subtype, accounting for 66.5% of all the cases. Patients in the CM and ALM subgroups with metastatic SLN ( p = 0.012) or lymph nodes ( p < 0.001 and p = 0.001) exhibited higher mortality rate. Multivariate analysis showed that patients with clinical presentation of T4 category tumor ( p = 0.012) and lymphovascular invasion ( p = 0.012) had a significantly higher risk of positive lymph nodes. The overall survival of patients with lymph nodes metastasis was not associated with the performance of CLND.

Conclusion: Patients in the CM or ALM subgroups with metastatic SLNs or lymph nodes exhibited significantly poorer overall survival. Advanced Breslow thickness and lymphovascular invasion were independent predictive factors for CM and ALM patients with positive lymph node status. There was no significant difference in survival between CM and ALM patients following SLNB, regardless of CLND being performed.

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Conflict of interest statement

Conflicts of interest: Dr. Hsu Ma, an editorial board member at Journal of the Chinese Medical Association , had no role in the peer review process of or decision to publish this article. The other authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article.

Figures

Fig. 1
Fig. 1
Estimated overall survival of patients with cutaneous malignant melanoma submitted to sentinel lymph node (A) and lymph node (B) status.
Fig. 2
Fig. 2
Estimated overall survival of patients with acral lentiginous melanoma submitted to sentinel lymph node (A) and lymph node (B) status.
Fig. 3
Fig. 3
Estimated overall survival of patients with cutaneous malignant melanoma (A) and acral lentiginous melanoma (B) according to CLND performed or nonperformed. CLND = completion lymph node dissection.
Fig. 4
Fig. 4
Estimated distant metastasis-free survival of patients with cutaneous malignant melanoma (A) and acral lentiginous melanoma (B) according to CLND performed or nonperformed. CLND = completion lymph node dissection.
See this image and copyright information in PMC

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