Validation of invasive area for predicting sentinel node status and survival in primary cutaneous melanoma

Orme, Sophie E., Bamford, Mark, O’Riordan, Marie, Da Forno, Philip D., Snelling, Andrew, Heaton, Martin J., Stanley, Rachael, Brunton-Sim, Roxanne, Moncrieff, Marc D. and Saldanha, Gerald (2025) Validation of invasive area for predicting sentinel node status and survival in primary cutaneous melanoma. Annals of Surgical Oncology. ISSN 1068-9265

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Abstract

Background: Two-dimensional histologic features have demonstrated independent prognostic value for survival in primary cutaneous melanoma, but their predictive value for sentinel node (SN) status has yet to be validated. We aimed to demonstrate the predictive value of the previously described calculated tumor area (CTA), and the novel Simplified Breslow Area (SBA), for SN metastasis and survival. Materials and Methods: A total of 177 primary melanomas were assessed for standard histological characteristics, maximum invasive width (IW) of the primary tumor and CTA. We simplified CTA measurement by transforming IW with Breslow thickness (BT) [ln(IW) + ln (BT)], yielding SBA. Multivariate analysis was undertaken to assess the performance of CTA and SBA, respectively, as independent predictors of both SN status and survival outcomes. Results: The SN + rate was 18.1% (32/177). The median CTA for SN−patients was 3.2 mm2 (IQR 1.2–10.9) compared with 6.7 mm2 (IQR 4.2–26.9) for SN + patients (p < 0.01). Maximum threshold analysis identified an optimal CTA cutoff point of 6.3 mm2 for disease-specific (DSS) [HR 1.01 (1.00–1.02); p = 0.008], distant metastasis-free [HR 1.01 (1.00–1.02); p = 0.005], and disease-free survival [HR 1.01 (1.00–1.02); p = 0.005]. The 5-year DSS for low-risk CTA tumors was 91.2% versus 61.3% for high-risk tumors. Cox regression showed CTA [HR 3.5 (1.21–10.81); p = 0.021] and ulceration status (US) were independent predictors of DSS. Similar results were obtained for SBA, which, on multivariate analysis, was the single most important predictor of SN status outperforming lymphovascular invasion, US, and BT. Conclusions: The two-dimensional histologic features CTA and SBA are independently prognostic for survival in primary cutaneous melanoma, and SBA may be a better predictor of SN status than BT.

Item Type:	Article
Uncontrolled Keywords:	surgery,oncology ,/dk/atira/pure/subjectarea/asjc/2700/2746
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Related URLs:	http://www.scopus.com/inward/record.url?...
Depositing User:	LivePure Connector
Date Deposited:	30 Jun 2025 11:30
Last Modified:	30 Jun 2025 11:30
URI:	https://ueaeprints.uea.ac.uk/id/eprint/99772
DOI:	10.1245/s10434-025-17442-2

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