Turkiye Klinikleri Journal of Dermatology

.: ORIGINAL RESEARCH
Clinicopathologic Analysis of 43 Acral Melanomas and the Relevance of Predictors of Sentinel Lymph Node Positivity
Akral Melanom Tanılı 43 Hastanın Klinikopatolojik Bulgularının ve Sentinel Lenf Nodu Pozitifliğini Etkileyen Belirteçlerin Değerlendirilmesi
Tuğba Kevser UZUNÇAKMAKa, Sera Nur YÜCESOYa, Özge AŞKINa, Övgü AYDINb, Ayşenur ÖZDİLc, Server SERDAROĞLUa
aDepartment of Dermatology and Venerology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, TURKEY
bDepartment of Medical Pathology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, TURKEY
cDepartment of Public Health, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, TURKEY
Turkiye Klinikleri J Dermatol. 2021;31(1):20-7
doi: 10.5336/dermato.2021-81257
Article Language: EN
Full Text
ABSTRACT
 Objective: Acral melanoma is an uncommon subtype of melanoma that occurs on palmoplantar surfaces and the nail unit. The prognosis is usually poorer as compared to other subtypes of melanoma due to the delayed diagnosis. Breslow thickness, age at diagnosis, ulceration, and the sentinel lymph node status are the main prognostic factors. In this retrospective study, we aimed to analyze the clinicopathological features of 43 acral melanoma patients and to determine the predictors of sentinel lymph node positivity. Material and Methods: A total of 43 patients who were diagnosed with acral melanoma at our department or consulted to our department from January 2010 to January 2020 were enrolled in this study. Demographic features and histopathological data were collected from medical records. The statistical analysis was performed with the SPSS 21. Results: The mean age of the patients was 62.7±13 (28-82). Breslow thickness was 5.80±6.15 mm (0-29). Sentinel lymph node involvement was negative in 27 (62.7%) patients. Ulceration was detected in 30 (69.7%) patients. A statistically significant relation was detected between sentinel lymph node positivity and Breslow thickness and number of mitosis (p<0.001). There was a statistically significant relation between the ulceration and mitosis (p=0.033). Also, the relation between the ulceration and Breslow thickness was statistically significant (p=0.011). A significant difference was established between the patients with lymphovascular invasion and a moderate negative correlation was detected between tumor-infiltrating lymphocytes in terms of the sentinel lymph node positivity. Conclusion: In cases with acral melanoma alongside Breslow thickness, ulceration, mitosis rate, and lymphovascular invasion are major predictors of sentinel lymph node positivity. As taking into consideration of the delayed prognosis of acral melanoma, in every patient presence and intensity of these parameters should be carefully evaluated during patient follow-up.

Keywords: Acral melanoma; Breslow thickness; sentinel lymph node; ulceration
ÖZET
 Amaç: Akral melanom, palmoplantar bölge ve tırnak ünitesini etkileyen, melanomun nadir görülen bir alt tipidir. Prognozu, sıklıkla tanıda gecikme olması nedeniyle diğer melanom alt tiplerine göre daha kötüdür. Breslow kalınlığı, hastanın tanı yaşı, ülserasyon varlığı ve sentinel lenf nodu pozitifliği ana prognostik faktörlerdir. Bu retrospektif çalışmada, akral melanom tanısı alan 43 hastanın klinikopatolojik özelliklerinin ve sentinel lenf nodu pozitifliğini etkileyebilecek faktörlerin incelenmesi amaçlanmıştır. Gereç ve Yöntemler: Bu çalışmaya, Ocak 2010 ve Ocak 2020 tarihleri arasında hastanemizde akral melanom tanısı alan veya kliniğimize konsülte edilen akral melanom tanısı almış 43 hasta dâhil edilmiştir. Hastalara ait demografik özellikler ve histopatolojik veriler, hasta kayıtlarından taranmıştır. İstatistiksel analiz, SPSS 21 ile yapılmıştır. Bulgular: Hastaların ortalama yaşı 62,7±13 (28-82), Breslow kalınlığı 5,80±6,15 mm (0-29) idi. Yirmi yedi (%62,7) hastada, sentinel lenf nodu tutulumu negatifti. Ülserasyon varlığı, 30 (%69,7) hastada tespit edildi. Sentinel lenf nodu pozitifliği ile Breslow kalınlığı ve mitoz sayısı arasında istatistiksel olarak anlamlı ilişki tespit edildi (p<0,001). Ülserasyon ile mitoz arasında istatistiksel olarak anlamlı bir ilişki izlendi (p=0,033). Ülserasyon ile Breslow kalınlığı arasındaki ilişki istatistiksel olarak anlamlıydı (p=0,011). Sentinel lenf nodu pozitifliği ile lenfovasküler invazyon arasında istatistiksel olarak anlamlı ilişki gözlenirken, tümör infiltre eden lenfosit yoğunluğu ile sentinel lenf nodu pozitifliği arasında orta derecede negatif korelasyon izlenmiştir. Sonuç: Akral melanomlu olgularda Breslow kalınlığı, ülserasyon varlığı, mitoz oranı ve lenfovasküler invazyon varlığı, sentinel lenf nodu pozitifliğinin başlıca belirteçleridir. Akral melanomun kötü prognozu göz önünde bulundurulduğunda, bu hastaların takipleri sırasında bu parametrelerin varlığı ve yoğunluğu dikkatli değerlendirilmelidir.

Anahtar Kelimeler: Akral melanom; Breslow kalınlığı; sentinel lenf nodu; ülserasyon
REFERENCES:
  1. Clark WH Jr, From L, Bernardino EA, Mihm MC. The histogenesis and biologic behavior of primary human malignant melanomas of the skin. Cancer Res. 1969;29(3):705-27.[PubMed] 
  2. Phan A, Touzet S, Dalle S, Ronger-Savlé S, Balme B, Thomas L. Acral lentiginous melanoma: a clinicoprognostic study of 126 cases. Br J Dermatol. 2006;155(3):561-9.[Crossref] [PubMed] 
  3. Liu L, Zhang W, Gao T, Li C. Is UV an etiological factor of acral melanoma? J Expo Sci Environ Epidemiol. 2016;26(6):539-45.[Crossref] [PubMed] 
  4. Balch CM, Gershenwald JE, Soong SJ, Thompson JF, Atkins MB, Byrd DR, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27(36):6199-206.[Crossref] [PubMed] [PMC] 
  5. Gershenwald JE, Ross MI. Sentinel-lymph-node biopsy for cutaneous melanoma. N Engl J Med. 2011;364(18):1738-45.[Crossref] [PubMed] 
  6. Gershenwald JE, Thompson W, Mansfield PF, Lee JE, Colome MI, Tseng CH, et al. Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients. J Clin Oncol. 1999;17(3):976-83.[Crossref] [PubMed] 
  7. Namikawa K, Aung PP, Gershenwald JE, Milton DR, Prieto VG. Clinical impact of ulceration width, lymphovascular invasion, microscopic satellitosis, perineural invasion, and mitotic rate in patients undergoing sentinel lymph node biopsy for cutaneous melanoma: a retrospective observational study at a comprehensive cancer center. Cancer Med. 2018;7(3):583-93.[Crossref] [PubMed] [PMC] 
  8. Aung PP, Nagarajan P, Prieto VG. Regression in primary cutaneous melanoma: etiopathogenesis and clinical significance. Lab Invest. 2017. Published online 27 February 2017.[Crossref] [PubMed] 
  9. Jung HJ, Kweon SS, Lee JB, Lee SC, Yun SJ. A clinicopathologic analysis of 177 acral melanomas in Koreans: relevance of spreading pattern and physical stress. JAMA Dermatol. 2013;149(11):1281-8.[Crossref] [PubMed] 
  10. Wei X, Wu D, Li H, Zhang R, Chen Y, Yao H, et al. The clinicopathological and survival profiles comparison across primary sites in acral melanoma. Ann Surg Oncol. 2020;27(9):3478-85.[Crossref] [PubMed] [PMC] 
  11. Nunes LF, Quintella Mendes GL, Koifman RJ. Acral melanoma: a retrospective cohort from the Brazilian National Cancer Institute (INCA). Melanoma Res. 2018;28(5):458-64.[Crossref] [PubMed] 
  12. Sheen YS, Liao YH, Lin MH, Chen JS, Liau JY, Tseng YJ, et al. A clinicopathological analysis of 153 acral melanomas and the relevance of mechanical stress. Sci Rep. 2017;7(1):5564.[Crossref] [PubMed] [PMC] 
  13. Lin CS, Wang WJ, Wong CK. Acral melanoma. A clinicopathologic study of 28 patients. Int J Dermatol. 1990;29(2):107-12.[Crossref] [PubMed] 
  14. Behbahani S, Malerba S, Samie FH. Acral lentiginous melanoma: clinicopathological characteristics and survival outcomes in the US National Cancer Database 2004-2016. Br J Dermatol. 2020;183(5):952-4.[Crossref] [PubMed] 
  15. Azzola MF, Shaw HM, Thompson JF, Soong SJ, Scolyer RA, Watson GF, et al. Tumor mitotic rate is a more powerful prognostic indicator than ulceration in patients with primary cutaneous melanoma: an analysis of 3661 patients from a single center. Cancer. 2003;97(6):1488-98.[Crossref] [PubMed] 
  16. Borkowska AM, Szumera-Ciećkiewicz A, Spałek MJ, Teterycz P, Czarnecka AM, Rutkowski PŁ. Clinicopathological features and prognostic factors of primary acral melanomas in Caucasians. J Clin Med. 2020;9(9):2996.[Crossref] [PubMed] [PMC] 
  17. Chen YJ, Wu CY, Chen JT, Shen JL, Chen CC, Wang HC. Clinicopathologic analysis of malignant melanoma in Taiwan. J Am Acad Dermatol. 1999;41(6):945-9.[Crossref] [PubMed] 
  18. Slingluff CL Jr, Vollmer R, Seigler HF. Acral melanoma: a review of 185 patients with identification of prognostic variables. J Surg Oncol. 1990;45(2):91-8.[Crossref] [PubMed] 
  19. Balch CM, Wilkerson JA, Murad TM, Soong SJ, Ingalls AL, Maddox WA. The prognostic significance of ulceration of cutaneous melanoma. Cancer. 1980;45(12):3012-7.[Crossref] [PubMed] 
  20. Callender GG, McMasters KM. What does ulceration of a melanoma mean for prognosis? Adv Surg. 2011;45:225-36.[Crossref] [PubMed] 
  21. Kwon MR, Choi SH, Jang KT, Kim JH, Mun GH, Lee J, et al. Acral malignant melanoma; emphasis on the primary metastasis and the usefulness of preoperative ultrasound for sentinel lymph node metastasis. Sci Rep. 2019;9(1):15894.[Crossref] [PubMed] [PMC] 
  22. Bello DM, Chou JF, Panageas KS, Brady MS, Coit DG, Carvajal RD, et al. Prognosis of acral melanoma: a series of 281 patients. Ann Surg Oncol. 2013;20(11):3618-25.[Crossref] [PubMed] 
  23. Paek SC, Griffith KA, Johnson TM, Sondak VK, Wong SL, Chang AE, et al. The impact of factors beyond Breslow depth on predicting sentinel lymph node positivity in melanoma. Cancer. 2007;109(1):100-8.[Crossref] [PubMed] 
  24. Kruper LL, Spitz FR, Czerniecki BJ, Fraker DL, Blackwood-Chirchir A, Ming ME, et al. Predicting sentinel node status in AJCC stage I/II primary cutaneous melanoma. Cancer. 2006;107(10):2436-45.[Crossref] [PubMed] 
  25. Wagner JD, Gordon MS, Chuang TY, Coleman JJ 3rd, Hayes JT, Jung SH, et al. Predicting sentinel and residual lymph node basin disease after sentinel lymph node biopsy for melanoma. Cancer. 2000;89(2):453-62.[Crossref] [PubMed] 
  26. Mraz-Gernhard S, Sagebiel RW, Kashani-Sabet M, Miller JR 3rd, Leong SP. Prediction of sentinel lymph node micrometastasis by histological features in primary cutaneous malignant melanoma. Arch Dermatol. 1998;134(8):983-7.[Crossref] [PubMed] 
  27. Nguyen CL, McClay EF, Cole DJ, O'Brien PH, Gillanders WE, Metcalf JS, et al. Melanoma thickness and histology predict sentinel lymph node status. Am J Surg. 2001;181(1):8-11.[Crossref] [PubMed] 
  28. Sondak VK, Taylor JM, Sabel MS, Wang Y, Lowe L, Grover AC, et al. Mitotic rate and younger age are predictors of sentinel lymph node positivity: lessons learned from the generation of a probabilistic model. Ann Surg Oncol. 2004;11(3):247-58.[Crossref] [PubMed] 
  29. Clary BM, Brady MS, Lewis JJ, Coit DG. Sentinel lymph node biopsy in the management of patients with primary cutaneous melanoma: review of a large single-institutional experience with an emphasis on recurrence. Ann Surg. 2001;233(2):250-8.[Crossref] [PubMed] [PMC] 
  30. Jansen L, Nieweg OE, Peterse JL, Hoefnagel CA, Olmos RA, Kroon BB. Reliability of sentinel lymph node biopsy for staging melanoma. Br J Surg. 2000;87(4):484-9.[Crossref] [PubMed] 
  31. Taylor RC, Patel A, Panageas KS, Busam KJ, Brady MS. Tumor-infiltrating lymphocytes predict sentinel lymph node positivity in patients with cutaneous melanoma. J Clin Oncol. 2007;25(7):869-75.[Crossref] [PubMed] 
  32. Fortes C, Mastroeni S, Caggiati A, Passarelli F, Ricci F, Michelozzi P. High level of TILs is an independent predictor of negative sentinel lymph node in women but not in men. Arch Dermatol Res. 2021;313(1):57-61.[Crossref] [PubMed] 
  33. Azimi F, Scolyer RA, Rumcheva P, Moncrieff M, Murali R, McCarthy SW, et al. Tumor-infiltrating lymphocyte grade is an independent predictor of sentinel lymph node status and survival in patients with cutaneous melanoma. J Clin Oncol. 2012;30(21):2678-83.[Crossref] [PubMed] 

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