In a multicenter study conducted at the M. D. Anderson Cancer Center in 580 melanoma patients, the SLN status was found to be the most significant prognostic factor with respect to disease-free survival and disease-specific survival according to univariate and multiple covariate analyses. Although the thickness of the primaries and ulceration influenced survival in SLN-negative cases, these properties provided no additional prognostic information in SLN-positive cases. Therefore, SLN exploration is beneficial, allowing an idea of the prognosis and the identification of patients who may benefit from early lymphadenectomy (Ger-shenwald et al. 1988, 1999).
The locoregional recurrence rate in melanoma patients seems to be important for judgments about the value of the SLN concept. To obtain clear-cut information, Gershenwald et al. (1998) looked for recurrence rates and patterns in 243 stage I and II melanoma cases in which SLNs were negative. The results were: 11% with negative SLNs developed local, in-transit, and regional nodal and/or distant metastases. In 4% metastases developed in the basin investigated. In 80% of the primarily negative nodes tumor cells were detected in serial sections supported by immunohistochemis-try (see also Chapter 21).
These data definitely show that node examinations performed by pathologists using only HE staining were incomplete, and that, as a consequence of the false-negative histopathological results, the clearance of the basins was also incomplete. It follows from this that improvements to quality and cooperation in early diagnosis can help to lower the recurrence rates.
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Complete Guide to Preventing Skin Cancer. We all know enough to fear the name, just as we do the words tumor and malignant. But apart from that, most of us know very little at all about cancer, especially skin cancer in itself. If I were to ask you to tell me about skin cancer right now, what would you say? Apart from the fact that its a cancer on the skin, that is.