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Comparison of Three Micromorphometric Pathology Classifications of Melanoma Metastases in the Sentinel Node

van der Ploeg, Iris M. C. MD, PhD*; Kroon, Bin B. R. MD, PhD, FRCS*; Antonini, Ninja MSc†; Valdés Olmos, Renato A. MD, PhD‡; Nieweg, Omgo E. MD, PhD*

doi: 10.1097/SLA.0b013e3181b1735b
Original Articles

Objective: The purposes of this study were to determine which classification best predicts additional lymph node disease and survival, and to suggest a threshold below which a completion dissection may be omitted.

Summary Background Data: Three micromorphometric parameters of melanoma sentinel node metastases were compared: invasion depth from the capsule (Starz-classification), maximum diameter (Rotterdam-criteria), and location within the node (Dewar-classification).

Methods: The pathology slides of 116 patients with tumor-positive sentinel nodes were reviewed. The follow-up data were obtained from the prospectively kept database. The median follow-up duration was 53 months.

Results: Metastases with an invasion depth under 0.3 mm or diameter less than 0.1 mm were not associated with additional involved nodes. Four percent of the patients with metastases with an invasion depth of 0.3 to 1.0 mm had other involved nodes and 3% of the patients with metastases with a diameter of 0.1 to 1.0 mm. Other nodes were involved in 3% of subcapsular metastases, 9% of both subcapsular and parenchymal metastases, and 33% in case of multifocal or extensive disease. The smallest tumor invasion depth and diameter associated with additional involved nodes was 0.4 mm. Only 5-year overall survival in the 3 successive invasion depth categories were statistically significant: 92%, 83%, and 68%. Five-year overall survival was 81% in patients with one involved sentinel node and 60% if there were more.

Conclusions: Invasion depth and diameter of the metastasis correlate best with the presence of additional nodal disease. Invasion depth best predicts overall survival. It seems justified to refrain from completion dissection in patients with a sentinel node tumor invasion depth up to 0.4 mm.

Three micromorphometric parameters of positive sentinel nodes were compared. The location of the metastasis within the node (Dewar-classification) was not predictive for additional metastases. Invasion depth (Starz-classification) and diameter (Rotterdam-criteria) of the metastasis correlated best with additional nodal disease. Invasion depth best predicted survival.

From the Departments of *Surgery, †Biometrics, and ‡Nuclear Medicine, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.

With this statement all authors mentioned in this article disclose that there are no financial or personal relationships with other people or organizations that could inappropriately influence (bias) this work. Examples of such potential conflicts of interest include employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, and grants, or other funding. All these examples of possible conflicts are not present in the current manuscript.

Each author certifies that he or she has participated sufficiently in the intellectual content, the analysis of data, if applicable, and the writing of the Work to take public responsibility for it. Each has reviewed the final version of the Work, believes it represents valid work, and approves it for publication. Moreover, should the editors of the Publication request the data upon which the work is based, they shall produce it.

Reprints: Iris M. C. van der Ploeg, MD, Department of Surgery, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.