Sentinel-Node Biopsy Improved DFS, Staging in Melanoma

Sentinel lymph node biopsy after wide excision improved DFS compared with wide excision alone among patients with intermediate and thick melanomas, according to final results of the MSLT-1 trial presented at the HemOnc Today Melanoma and Cutaneous Malignancies meeting in New York.

“ ‘We found that performing sentinel lymph node biopsy is very accurate and improves staging in order to determine whether additional treatments are needed, such as additional surgery or adjuvant systemic therapy,’ Robert H.I. Andtbacka, MD, CM, FACS, FRCSC, associate professor of surgery at Huntsman Cancer Institute at the University of Utah, said during a presentation. ‘It also forms a basis for us to perform all the subsequent studies that we do in melanoma to make sure patients we have for our clinical trials are well balanced.’ “

Editor’s note: DFS stands for disease-free survival.

Nonsentinel Lymph Node Status in Melanoma Has Prognostic Value

“Nonsentinel lymph node (NSLN) status in patients who underwent complete lymph node dissection after positive sentinel lymph node biopsy (SLNB) had independent prognostic value in patients with two to three positive lymph nodes, according to the results of a study published recently in the Journal of Clinical Oncology.

“Furthermore, researchers led by Sandro Pasquali, MD, of the University of Padova, Italy, found that patients who had metastatic disease in their NSLN had their risk for melanoma death increased by more than one-third.”

Editor’s note: Sentinel lymph nodes (those closest to the tumor) can be examined to predict whether a patient will survive melanoma. This study shows that nonsentinel lymph nodes could potentially be used for survival predictions. We covered a similar story last July.

Non-Invasive Gene Expression Profile Test Shown to Identify Sentinel Lymph Node Negative Melanoma Patients at High Risk of Metastasis

“Castle Biosciences Inc. has announced study results showing its gene expression profile (GEP) test (DecisionDx-Melanoma) can identify primary cutaneous (skin) melanoma tumors that are likely to metastasize in patients who had a negative sentinel lymph node biopsy. The data are being presented at the Latest in Dermatology Research Symposium session of the 72nd Annual Meeting of the American Academy of Dermatology. The DecisionDx-Melanoma test completed validation in 2013 and is widely used to determine metastatic risk in Stage I and II melanoma patients.”

Super Patient: Chelsea Price Takes Charge of Stage III Melanoma

Late in 2010, Chelsea Price’s boyfriend noticed that a mole on her upper back was scabbed and weeping. “It had always been there but he thought I should get it checked,” recalls Chelsea, who was then 23 years old. By the time her dermatology appointment rolled around, however, the mole had healed. “I almost cancelled,” she says.

Good thing she didn’t. At her follow-up appointment, her dermatologist casually said, “Hey, it’s melanoma.” Thinking he was kidding, Chelsea started laughing. When she realized he was serious, she was stunned. Continue reading…

The Number of Tumor Cells Spread to Sentinel Lymph Nodes Affects Melanoma Prognosis

“Cancer cell spread to the sentinel node — the lymph node to which cancer cells are most likely to spread from a primary tumor — is a risk factor for melanoma death. The prognosis of a patient largely depends on the number of disseminated cancer cells per million lymphocytes in the sentinel node. Even very low numbers were found to be predictive for reduced survival.”

New Targetable Protein Linked to Melanoma Spread

New research suggests that melanomas are more likely to spread in people whose sentinel lymph nodes (SNLs) contain a particular subtype of white blood cells (lymphocytes). The researchers studied 42 people with melanoma, and found that tumors were more likely to spread within five years when their SNL lymphocytes had a surface protein called CD30. Moreover, this lymphocyte type was also more common in the blood of 25 people with advanced melanoma. These findings suggest that CD30 could be a target from treating melanoma, which is encouraging because the FDA has already approved a drug (brentuximab vedotin or Adcetris) that targets this protein for lymphoma treatment.

Melanoma Survival Drops When Nonsentinel Nodes Contain Tumor Cells

The likelihood that people will survive melanoma is often based on whether the sentinel lymph nodes—those closest to the tumor—contain cancer cells. But new research suggests that the status of other nodes can also help predict survival. The researchers assessed 329 melanoma patients with ‘positive’ sentinel nodes, and found that ‘nonsentinel’ nodes were also positive in 24% of the patients. People with positive nonsentinel nodes had higher rates of tumor recurrence, and sharply lower rates of 5-year survival (46% vs 72% for those who only had positive sentinel nodes). In addition, those with positive nonsentinel nodes were also more likely to be older and to have tumors that were thicker and ulcerated.