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
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