Analysis of Sentinel Node Biopsy and Clinicopathologic Features as Prognostic Factors in Patients With Atypical Melanocytic Tumors

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  • 1 Melanoma and Sarcoma Unit,
  • 2 Medical Statistics, Biometry and Bioinformatics Unit, and
  • 3 Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy;
  • 4 Dermatology Unit, Ospedale Umberto I, Siracusa, Italy;
  • 5 Dermatology Unit, Ospedale S.A. Abate, Trapani, Italy;
  • 6 University Hospital of Modena, Modena, Italy;
  • 7 University Hospital of Parma, Parma, Italy;
  • 8 Dermatology Unit, Hospital of Macerata, Macerata, Italy;
  • 9 University Hospital of Brescia, Brescia, Italy;
  • 10 University Hospital of Pavia, Pavia, Italy;
  • 11 Dermatology Unit, Ospedale Maggiore, Cremona, Italy;
  • 12 Queen Mary University of London, London, United Kingdom;
  • 13 York Teaching Hospital NHS Foundation Trust, York, United Kingdom;
  • 14 University Hospital of Heraklion, Heraklion, Greece;
  • 15 Molecular and Clinical Sciences Research Institute, St. George’s, University of London, London, United Kingdom;
  • 16 Istituto Oncologico Svizzera Italiana, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland; and
  • 17 Department of Pathology,
  • 18 Scientific Directorate, and
  • 19 Immunobiology of Human Tumors Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
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Background: Atypical melanocytic tumors (AMTs) include a wide spectrum of melanocytic neoplasms that represent a challenge for clinicians due to the lack of a definitive diagnosis and the related uncertainty about their management. This study analyzed clinicopathologic features and sentinel node status as potential prognostic factors in patients with AMTs. Patients and Methods: Clinicopathologic and follow-up data of 238 children, adolescents, and adults with histologically proved AMTs consecutively treated at 12 European centers from 2000 through 2010 were retrieved from prospectively maintained databases. The binary association between all investigated covariates was studied by evaluating the Spearman correlation coefficients, and the association between progression-free survival and all investigated covariates was evaluated using univariable Cox models. The overall survival and progression-free survival curves were established using the Kaplan-Meier method. Results: Median follow-up was 126 months (interquartile range, 104–157 months). All patients received an initial diagnostic biopsy followed by wide (1 cm) excision. Sentinel node biopsy was performed in 139 patients (58.4%), 37 (26.6%) of whom had sentinel node positivity. There were 4 local recurrences, 43 regional relapses, and 8 distant metastases as first events. Six patients (2.5%) died of disease progression. Five patients who were sentinel node–negative and 3 patients who were sentinel node–positive developed distant metastases. Ten-year overall and progression-free survival rates were 97% (95% CI, 94.9%–99.2%) and 82.2% (95% CI, 77.3%–87.3%), respectively. Age, mitotic rate/mm2, mitoses at the base of the lesion, lymphovascular invasion, and 9p21 loss were factors affecting prognosis in the whole series and the sentinel node biopsy subgroup. Conclusions: Age >20 years, mitotic rate >4/mm2, mitoses at the base of the lesion, lymphovascular invasion, and 9p21 loss proved to be worse prognostic factors in patients with ATMs. Sentinel node status was not a clear prognostic predictor.

Submitted September 16; 2019; accepted for publication April 28, 2020.

Author contributions: Study concept: Maurichi, Miceli, Anichini, Mortarini, Santinami. Data acquisition: Patuzzo, Gallino, Mattavelli, Barbieri, Leva, Cortinovis, Tolomio, Sant, Castelli, Zichichi, Pellacani, Stanganelli, Simonacci, Manganoni, Del Forno, Caresana, Harwood, Lasithiotakis, Espeli, Mangas, Zoras. Data analysis and interpretation: Maurichi, Patuzzo, Leoni Parvex, Valeri, Cossa, Barisella, Pellegrinelli, Santinami. Statistical analysis: Miceli, Barretta. Manuscript preparation: Maurichi, Miceli, Barretta, Bergamaschi, Bennett, Miranda. Manuscript review and editing: All authors.

Disclosures: The authors have disclosed that they have not received any financial considerations from any person or organization to support the preparation, analysis, results, or discussion of this article.

Correspondence: Andrea Maurichi, MD, Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Giacomo Venezian 1, 20133 Milan, Italy. Email: andrea.maurichi@istitutotumori.mi.it

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