Melanoma Thickness Predicts Virulence, Need for Sentinel Node Sampling

Laurie Barclay, MD

March 21, 2003

March 21, 2003 — The thickness of melanoma indicates its virulence and the need for sentinel node sampling, according to the results of a study published in the March issue of the Archives of Dermatology. Using the combination of ultrasound and digital videomicroscopy, investigators correctly classified thin melanomas 100% of the time, suggesting that this noninvasive procedure could avoid many unnecessary operations.

"Sentinel lymph node surgery is suggested for patients with primary melanomas 1 mm or greater in depth," write Giovanni Pellacani, MD, and Stefania Seidenari, MD, from the University of Modena in Italy. "Since surgical manipulation may cause scarring and damage to the lymphatic vessels,...performing sentinel lymph node mapping preoperatively would represent the ideal procedure."

In a training set of 40 primary cutaneous melanomas, the authors determined ultrasonographic thickness with a 20-MHz B-scanner and identified clinical and videomicroscopic variables that helped distinguish thick from thin melanomas. Features suggesting thin melanomas were nonpalpability, central pigment network, central brown globules, and blotches, whereas clinical regression, localized peripheral pigment network, veil, grayish polygonal areas, and blood vessels were characteristic of thick melanomas.

Based on echographic, clinical, and videomicroscopic criteria, the authors constructed an algorithm for preoperative evaluation of melanoma thickness and validated it on a test set of 48 melanomas. This algorithm allowed diagnosis of thick melanomas with sensitivity of 86.7% and specificity of 100%.

"The correct classification of all thin melanomas as such renders this approach suitable in clinical practice," the authors write. "Our management strategy guarantees the advantages of certain identification of the sentinel lymph node by performing node mapping when the lesion is still in situ, and of a simultaneous surgical treatment."

Arch Dermatol. 2003;139:293-298

Reviewed by Gary D. Vogin, MD

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