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Original Investigation |

Correlation of Histologic Regression in Primary Melanoma With Sentinel Node Status ONLINE FIRST

Rafael Botella-Estrada, MD, PhD1,2; Victor Traves, MD3; Celia Requena, MD, PhD1; Carlos Guillen-Barona, MD, PhD1; Eduardo Nagore, MD, PhD1
[+] Author Affiliations
1Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
2now with Department of Dermatology, Hospital Universitario La Fe and University of Valencia, Valencia, Spain
3Department of Pathology, Instituto Valenciano de Oncología, Valencia, Spain
JAMA Dermatol. Published online June 04, 2014. doi:10.1001/jamadermatol.2013.9856
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Importance  The influence of regression on the status of the sentinel node (SN) is controversial. In many centers, the presence of regression in thin melanomas supports the performance of an SN biopsy.

Objective  To identify whether regression in primary melanoma has any influence on SN involvement.

Design, Setting, and Participants  Retrospective study of melanomas with a Breslow thickness greater than 0.75 mm and undergoing SN biopsy from January 1, 2003, through December 31, 2010, at Instituto Valenciano de Oncología, which receives melanoma patients from regional hospitals and dermatology practices. Only cases with paraffin blocks or histologic slides representative of the primary tumor and available for review were included in the study. Melanomas from 201 patients met these criteria and constitute the core of this study.

Exposures  Sentinel node biopsy in melanoma.

Main Outcomes and Measures  Presence or absence of regression in the primary melanoma, type (early vs late), and extension were correlated with the presence or absence of metastasis in the SNs. In addition, the main clinical and histologic characteristics of the primary melanoma were correlated with the status of SN and the regression features.

Results  Regression was found in 52 melanomas (25.9%). Regression did not show a statistically significant association with SN status. When melanomas were subdivided by Breslow thickness into 4 groups, those with regression had a lower frequency of positive SNs in 3 of the 4 groups (≤1.00, 1.01-2.00, and >4.00 mm), although differences did not reach statistical significance in any group. We found no influence by type of regression or its extension on the SN status. Regression was found more frequently in thin melanomas (≤1.00 mm), melanomas located on an axial site, and superficial spreading or lentigo maligna melanoma types (P = .02, P < .001, and P = .03, respectively).

Conclusions and Relevance  Regression of the primary melanoma is not associated with a higher proportion of positive SNs. These data do not support the practice of performing SN biopsy in thin melanomas with regression in the absence of additional adverse prognostic characteristics.

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Figure 1.
Histopathologic Findings in Early and Late Regression

A, Dense inflammatory infiltrate, capillary vessels, and subtle fibrosis were present in early regression (hematoxylin-eosin, original magnification ×200). B, Extensive fibrosis, numerous vessels, and flattening of the epidermis were typical of late regression (hematoxylin-eosin, original magnification ×100).

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Figure 2.
Correlation of Sentinel Node (SN) Metastasis With Regression

Melanomas with SN metastasis were divided according to the presence or absence of regression. For this comparison, melanomas were subdivided by Breslow thickness into the following 4 groups: 1.00 mm or less, 1.01 to 2.00 mm, 2.01 to 4.00 mm, and greater than 4.00 mm. Melanomas with regression had a lower frequency of positive SNs in 3 of the 4 groups. Differences did not reach statistical significance. MM indicates malignant melanoma.

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