Association of Histologic Regression in Primary Melanoma With Sentinel Lymph Node Status: A Systematic Review and Meta-analysis | Dermatology | JAMA Dermatology | JAMA Network
[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 34.234.207.100. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
1.
Kang  S, Barnhill  RL, Mihm  MC  Jr, Sober  AJ.  Histologic regression in malignant melanoma: an interobserver concordance study.  J Cutan Pathol. 1993;20(2):126-129.PubMedGoogle ScholarCrossref
2.
Requena  C, Botella-Estrada  R, Traves  V, Nagore  E, Almenar  S, Guillén  C.  Problems in defining melanoma regression and prognostic implication [in Spanish].  Actas Dermosifiliogr. 2009;100(9):759-766.PubMedGoogle ScholarCrossref
3.
Blessing  K, McLaren  KM.  Histological regression in primary cutaneous melanoma: recognition, prevalence and significance.  Histopathology. 1992;20(4):315-322.PubMedGoogle ScholarCrossref
4.
Ribero  S, Osella-Abate  S, Sanlorenzo  M,  et al.  Favourable prognostic role of regression of primary melanoma in AJCC stage I-II patients.  Br J Dermatol. 2013;169(6):1240-1245.PubMedGoogle ScholarCrossref
5.
Morton  DL, Cochran  AJ, Thompson  JF,  et al; Multicenter Selective Lymphadenectomy Trial Group.  Sentinel node biopsy for early-stage melanoma: accuracy and morbidity in MSLT-I, an international multicenter trial.  Ann Surg. 2005;242(3):302-311.PubMedGoogle Scholar
6.
Lourari  S, Paul  C, Gouraud  PA,  et al; Skin Oncology Working Group of the Société Française de Dermatologie (French Society of Dermatology).  Sentinel lymph node biopsy for melanoma is becoming a consensus: a national survey of French centres involved in melanoma care in 2008.  J Eur Acad Dermatol Venereol. 2012;26(10):1230-1235.PubMedGoogle ScholarCrossref
7.
Kaur  C, Thomas  RJ, Desai  N,  et al.  The correlation of regression in primary melanoma with sentinel lymph node status.  J Clin Pathol. 2008;61(3):297-300.PubMedGoogle ScholarCrossref
8.
Socrier  Y, Lauwers-Cances  V, Lamant  L,  et al.  Histological regression in primary melanoma: not a predictor of sentinel lymph node metastasis in a cohort of 397 patients.  Br J Dermatol. 2010;162(4):830-834.PubMedGoogle ScholarCrossref
9.
Morton  DL, Thompson  JF, Cochran  AJ,  et al; MSLT Group.  Final trial report of sentinel-node biopsy versus nodal observation in melanoma.  N Engl J Med. 2014;370(7):599-609.PubMedGoogle ScholarCrossref
10.
Ribero  S, Osella-Abate  S, Sanlorenzo  M,  et al.  Sentinel lymph node biopsy in thick-melanoma patients (N=350): what is its prognostic role?  Ann Surg Oncol. 2015;22(6):1967-1973.PubMedGoogle ScholarCrossref
11.
Shaw  HM, McCarthy  SW, McCarthy  WH, Thompson  JF, Milton  GW.  Thin regressing malignant melanoma: significance of concurrent regional lymph node metastases.  Histopathology. 1989;15(3):257-265.PubMedGoogle ScholarCrossref
12.
White  RL  Jr, Ayers  GD, Stell  VH,  et al; Sentinel Lymph Node Working Group.  Factors predictive of the status of sentinel lymph nodes in melanoma patients from a large multicenter database.  Ann Surg Oncol. 2011;18(13):3593-3600.PubMedGoogle ScholarCrossref
13.
Balch  CM, Gershenwald  JE, Soong  SJ,  et al.  Final version of 2009 AJCC melanoma staging and classification.  J Clin Oncol. 2009;27(36):6199-6206.PubMedGoogle ScholarCrossref
14.
Wong  SL, Balch  CM, Hurley  P,  et al; American Society of Clinical Oncology; Society of Surgical Oncology.  Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology joint clinical practice guideline.  J Clin Oncol. 2012;30(23):2912-2918.PubMedGoogle ScholarCrossref
15.
Panic  N, Leoncini  E, de Belvis  G, Ricciardi  W, Boccia  S.  Evaluation of the endorsement of the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement on the quality of published systematic review and meta-analyses.  PLoS One. 2013;8(12):e83138.PubMedGoogle ScholarCrossref
16.
Prictor  M, Hill  S.  Cochrane Consumers and Communication Review Group: leading the field on health communication evidence.  J Evid Based Med. 2013;6(4):216-220.PubMedGoogle ScholarCrossref
17.
Kuller  LH, Goldstein  BD.  Suggestions for STROBE recommendations.  Epidemiology. 2007;18(6):792-793.PubMedGoogle ScholarCrossref
18.
Han  D, Zager  JS, Shyr  Y,  et al.  Clinicopathologic predictors of sentinel lymph node metastasis in thin melanoma.  J Clin Oncol. 2013;31(35):4387-4393.PubMedGoogle ScholarCrossref
19.
Botella-Estrada  R, Traves  V, Requena  C, Guillen-Barona  C, Nagore  E.  Correlation of histologic regression in primary melanoma with sentinel node status.  JAMA Dermatol. 2014;150(8):828-835.PubMedGoogle ScholarCrossref
20.
Grotz  TE, Vaince  F, Hieken  TJ.  Tumor-infiltrating lymphocyte response in cutaneous melanoma in the elderly predicts clinical outcomes.  Melanoma Res. 2013;23(2):132-137.PubMedGoogle ScholarCrossref
21.
Testori  A, De Salvo  GL, Montesco  MC,  et al; Italian Melanoma Intergroup.  Clinical considerations on sentinel node biopsy in melanoma from an Italian multicentric study on 1,313 patients (SOLISM-IMI).  Ann Surg Oncol. 2009;16(7):2018-2027.PubMedGoogle ScholarCrossref
22.
Gutzmer  R, Satzger  I, Thoms  KM,  et al.  Sentinel lymph node status is the most important prognostic factor for thick (> or = 4 mm) melanomas.  J Dtsch Dermatol Ges. 2008;6(3):198-203.PubMedGoogle ScholarCrossref
23.
Morris  KT, Busam  KJ, Bero  S, Patel  A, Brady  MS.  Primary cutaneous melanoma with regression does not require a lower threshold for sentinel lymph node biopsy.  Ann Surg Oncol. 2008;15(1):316-322.PubMedGoogle ScholarCrossref
24.
Topping  A, Dewar  D, Rose  V,  et al.  Five years of sentinel node biopsy for melanoma: the St George’s Melanoma Unit experience.  Br J Plast Surg. 2004;57(2):97-104.PubMedGoogle ScholarCrossref
25.
Wagner  JD, Gordon  MS, Chuang  TY,  et al.  Predicting sentinel and residual lymph node basin disease after sentinel lymph node biopsy for melanoma.  Cancer. 2000;89(2):453-462.PubMedGoogle ScholarCrossref
26.
Tejera-Vaquerizo  A, Nagore  E, Herrera-Acosta  E,  et al.  Prediction of sentinel lymph node positivity by growth rate of cutaneous melanoma.  Arch Dermatol. 2012;148(5):577-584.PubMedGoogle ScholarCrossref
27.
Callender  GG, Egger  ME, Burton  AL,  et al.  Prognostic implications of anatomic location of primary cutaneous melanoma of 1 mm or thicker.  Am J Surg. 2011;202(6):659-664.PubMedGoogle ScholarCrossref
28.
Mandalà  M, Imberti  GL, Piazzalunga  D,  et al.  Clinical and histopathological risk factors to predict sentinel lymph node positivity, disease-free and overall survival in clinical stages I-II AJCC skin melanoma: outcome analysis from a single-institution prospectively collected database.  Eur J Cancer. 2009;45(14):2537-2545.PubMedGoogle ScholarCrossref
29.
Kruper  LL, Spitz  FR, Czerniecki  BJ,  et al.  Predicting sentinel node status in AJCC stage I/II primary cutaneous melanoma.  Cancer. 2006;107(10):2436-2445.PubMedGoogle ScholarCrossref
30.
Liszkay  G, Orosz  Z, Péley  G,  et al.  Relationship between sentinel lymph node status and regression of primary malignant melanoma.  Melanoma Res. 2005;15(6):509-513.PubMedGoogle ScholarCrossref
31.
Savoia  P, Fava  P, Caliendo  V,  et al.  Disease progression in melanoma patients with negative sentinel lymph node: does false-negative specimens entirely account for this phenomenon?  J Eur Acad Dermatol Venereol. 2012;26(2):242-248.PubMedGoogle ScholarCrossref
32.
Ribero  S, Quaglino  P, Osella-Abate  S,  et al.  Relevance of multiple basin drainage and primary histologic regression in prognosis of trunk melanoma patients with negative sentinel lymph nodes.  J Eur Acad Dermatol Venereol. 2013;27(9):1132-1137.PubMedGoogle ScholarCrossref
33.
Ma  MW, Medicherla  RC, Qian  M,  et al.  Immune response in melanoma: an in-depth analysis of the primary tumor and corresponding sentinel lymph node.  Mod Pathol. 2012;25(7):1000-1010.PubMedGoogle ScholarCrossref
Original Investigation
December 2015

Association of Histologic Regression in Primary Melanoma With Sentinel Lymph Node Status: A Systematic Review and Meta-analysis

Author Affiliations
  • 1Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
  • 2Section of Dermatologic Surgery, Department of Oncology and Hematology, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
  • 3Department of Public Health, University of Turin, Turin, Italy
  • 4Section of Surgical Pathology, Department of Medical Sciences, University of Turin, Turin, Italy
JAMA Dermatol. 2015;151(12):1301-1307. doi:10.1001/jamadermatol.2015.2235
Abstract

Importance  The prognostic significance of regression in primary melanoma has been debated for many years. There is no consensus regarding the need for sentinel lymph node (SLN) biopsy when regression is present within the primary tumor.

Objective  To review the evidence that regression may affect SLN status.

Data Sources  A systematic review was performed by searching in MEDLINE, Scopus, and the Cochrane Library from January 1, 1990, through June 2014.

Study Selection  All studies that reported an odds ratio (OR) or data on expected and observed cases of SLN positivity and histologic regression were included.

Data Extraction and Synthesis  Primary random-effects meta-analyses were used to summarize ORs of SLN positivity and histologic regression. Heterogeneity was assessed using the χ2 test and I2 statistic. To assess the potential bias of small studies, we used funnel plots, the Begg rank correlation test, and the Egger weighted linear regression test. The methodologic quality of the studies was assessed according to the Strengthening of Reporting of Observational studies in Epidemiology (STROBE) checklist, and 2 different meta-analyses were performed based on those criteria.

Main Outcomes and Measures  Summary ORs of histologic regression of primary melanoma and SLN status.

Results  Of the 1509 citations found in the search, 94 articles were reviewed, and 14 studies comprising 10 098 patients were included in the analysis. In the combined 14 studies, patients with regression had a lower likelihood to have SLN positivity (OR, 0.56; 95% CI, 0.41-0.77) than patients without regression. On the basis of study quality, we found that patients with regression enrolled in high-quality studies had a lower likelihood to have SLN positivity (OR, 0.48; 95% CI, 0.32-0.72) compared with results of low-quality studies (OR, 0.73; 95% CI, 0.53-1.00). Examination of the funnel plot did not provide evidence of publication bias.

Conclusions and Relevance  The results of this analysis showed that the risk of SLN positivity was significantly lower in patients with histologic regression compared with those without. Regression may be used in these cases to make a selection of which patients should be the most appropriate for this procedure.

×