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

Authors:
Andrea Maurichi Melanoma and Sarcoma Unit,

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Rosalba Miceli Medical Statistics, Biometry and Bioinformatics Unit, and

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Roberto Patuzzo Melanoma and Sarcoma Unit,

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Francesco Barretta Medical Statistics, Biometry and Bioinformatics Unit, and

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Gianfranco Gallino Melanoma and Sarcoma Unit,

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Ilaria Mattavelli Melanoma and Sarcoma Unit,

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Consuelo Barbieri Melanoma and Sarcoma Unit,

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Andrea Leva Melanoma and Sarcoma Unit,

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Umberto Cortinovis Melanoma and Sarcoma Unit,

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Elena Tolomio Melanoma and Sarcoma Unit,

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Milena Sant Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy;

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Gianpiero Castelli Dermatology Unit, Ospedale Umberto I, Siracusa, Italy;

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Leonardo Zichichi Dermatology Unit, Ospedale S.A. Abate, Trapani, Italy;

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Giovanni Pellacani University Hospital of Modena, Modena, Italy;

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Ignazio Stanganelli University Hospital of Parma, Parma, Italy;

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Marco Simonacci Dermatology Unit, Hospital of Macerata, Macerata, Italy;

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Ausilia Manganoni University Hospital of Brescia, Brescia, Italy;

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Corrado Del Forno University Hospital of Pavia, Pavia, Italy;

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Gioachino Caresana Dermatology Unit, Ospedale Maggiore, Cremona, Italy;

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Catherine Harwood Queen Mary University of London, London, United Kingdom;

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Daniele Bergamaschi Queen Mary University of London, London, United Kingdom;

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Konstantinos Lasithiotakis York Teaching Hospital NHS Foundation Trust, York, United Kingdom;
University Hospital of Heraklion, Heraklion, Greece;

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Dorothy Bennett Molecular and Clinical Sciences Research Institute, St. George’s, University of London, London, United Kingdom;

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Vittoria Espeli Istituto Oncologico Svizzera Italiana, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland; and

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Cristina Mangas Istituto Oncologico Svizzera Italiana, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland; and

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Sandra Leoni Parvex Istituto Oncologico Svizzera Italiana, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland; and

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Barbara Valeri Department of Pathology,

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Mara Cossa Department of Pathology,

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Marta Barisella Department of Pathology,

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Alessandro Pellegrinelli Department of Pathology,

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Claudia Miranda Scientific Directorate, and

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Andrea Anichini Immunobiology of Human Tumors Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.

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Roberta Mortarini Immunobiology of Human Tumors Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.

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Odysseas Zoras University Hospital of Heraklion, Heraklion, Greece;

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Mario Santinami Melanoma and Sarcoma Unit,

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Volume/Issue:
Volume 18: Issue 10
Online Publication Date:
01 Oct 2020
DOI:
https://doi.org/10.6004/jnccn.2020.7582
Restricted access

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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Print ISSN:
1540-1405
Online ISSN:
1540-1413
Publisher:
National Comprehensive Cancer Network
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Copyright:
Copyright © 2020 by the National Comprehensive Cancer Network 2020
Page Numbers:
10
Article Category:
Research Article
Accepted:
28 Apr 2020
Print Publication Date:
01 Oct 2020
Online Publication Date:
01 Oct 2020

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