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Melanoma: HELP
Articles by Sandra L. Wong
Based on 29 articles published since 2009
(Why 29 articles?)
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Between 2009 and 2019, S. L. Wong wrote the following 29 articles about Melanoma.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline Sentinel Lymph Node Biopsy and Management of Regional Lymph Nodes in Melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Clinical Practice Guideline Update. 2018

Wong, Sandra L / Faries, Mark B / Kennedy, Erin B / Agarwala, Sanjiv S / Akhurst, Timothy J / Ariyan, Charlotte / Balch, Charles M / Berman, Barry S / Cochran, Alistair / Delman, Keith A / Gorman, Mark / Kirkwood, John M / Moncrieff, Marc D / Zager, Jonathan S / Lyman, Gary H. ·Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. · The Angeles Clinic and Research Institute, Santa Monica, CA, USA. · American Society of Clinical Oncology, Alexandria, VA, USA. guidelines@asco.org. · St Luke's Cancer Center, Easton, PA, USA. · Peter MacCallum Cancer Centre, Melbourne, VIC, Australia. · Memorial Sloan Kettering Cancer Center, New York, NY, USA. · MD Anderson Cancer Center, Houston, TX, USA. · Broward Health, Fort Lauderdale, FL, USA. · Los Angeles Center for Health Services, University of California, Los Angeles, CA, USA. · Emory University, Atlanta, GA, USA. · , Silver Spring, MD, USA. · University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA. · Norfolk and Norwich University Hospital, Norwich, UK. · H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA. · Fred Hutchinson Cancer Research Center, Seattle, WA, USA. ·Ann Surg Oncol · Pubmed #29236202.

ABSTRACT: PURPOSE: To update the American Society of Clinical Oncology (ASCO)-Society of Surgical Oncology (SSO) guideline for sentinel lymph node (SLN) biopsy in melanoma. METHODS: An ASCO-SSO panel was formed, and a systematic review of the literature was conducted regarding SLN biopsy and completion lymph node dissection (CLND) after a positive sentinel node in patients with melanoma. RESULTS: Nine new observational studies, two systematic reviews and an updated randomized controlled trial (RCT) of SLN biopsy, as well as two randomized controlled trials of CLND after positive SLN biopsy, were included. RECOMMENDATIONS: Routine SLN biopsy is not recommended for patients with thin melanomas that are T1a (non-ulcerated lesions < 0.8 mm in Breslow thickness). SLN biopsy may be considered for thin melanomas that are T1b (0.8 to 1.0 mm Breslow thickness or <0.8 mm Breslow thickness with ulceration) after a thorough discussion with the patient of the potential benefits and risk of harms associated with the procedure. SLN biopsy is recommended for patients with intermediate-thickness melanomas (T2 or T3; Breslow thickness of >1.0 to 4.0 mm). SLN biopsy may be recommended for patients with thick melanomas (T4; > 4.0 mm in Breslow thickness), after a discussion of the potential benefits and risks of harm. In the case of a positive SLN biopsy, CLND or careful observation are options for patients with low-risk micrometastatic disease, with due consideration of clinicopathological factors. For higher risk patients, careful observation may be considered only after a thorough discussion with patients about the potential risks and benefits of foregoing CLND. Important qualifying statements outlining relevant clinicopathological factors, and details of the reference patient populations are included within the guideline.

2 Guideline Sentinel Lymph Node Biopsy and Management of Regional Lymph Nodes in Melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Clinical Practice Guideline Update. 2018

Wong, Sandra L / Faries, Mark B / Kennedy, Erin B / Agarwala, Sanjiv S / Akhurst, Timothy J / Ariyan, Charlotte / Balch, Charles M / Berman, Barry S / Cochran, Alistair / Delman, Keith A / Gorman, Mark / Kirkwood, John M / Moncrieff, Marc D / Zager, Jonathan S / Lyman, Gary H. ·Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH · Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica · Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA · Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA · Sanjiv S. Agarwala, St Luke's Cancer Center, Easton · John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA · Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia · Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY · Charles M. Balch, MD Anderson Cancer Center, Houston, TX · Barry S. Berman, Broward Health, Fort Lauderdale · Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL · Keith A. Delman, Emory University, Atlanta, GA · Mark Gorman, Silver Spring, MD · Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom · and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA. ·J Clin Oncol · Pubmed #29232171.

ABSTRACT: Purpose To update the American Society of Clinical Oncology (ASCO)-Society of Surgical Oncology (SSO) guideline for sentinel lymph node (SLN) biopsy in melanoma. Methods An ASCO-SSO panel was formed, and a systematic review of the literature was conducted regarding SLN biopsy and completion lymph node dissection (CLND) after a positive sentinel node in patients with melanoma. Results Nine new observational studies, two systematic reviews, and an updated randomized controlled trial of SLN biopsy, as well as two randomized controlled trials of CLND after positive SLN biopsy, were included. Recommendations Routine SLN biopsy is not recommended for patients with thin melanomas that are T1a (nonulcerated lesions < 0.8 mm in Breslow thickness). SLN biopsy may be considered for thin melanomas that are T1b (0.8 to 1.0 mm Breslow thickness or < 0.8 mm Breslow thickness with ulceration) after a thorough discussion with the patient of the potential benefits and risk of harms associated with the procedure. SLN biopsy is recommended for patients with intermediate-thickness melanomas (T2 or T3; Breslow thickness of > 1.0 to 4.0 mm). SLN biopsy may be recommended for patients with thick melanomas (T4; > 4.0 mm in Breslow thickness), after a discussion of the potential benefits and risks of harm. In the case of a positive SLN biopsy, CLND or careful observation are options for patients with low-risk micrometastatic disease, with due consideration of clinicopathological factors. For higher-risk patients, careful observation may be considered only after a thorough discussion with patients about the potential risks and benefits of foregoing CLND. Important qualifying statements outlining relevant clinicopathological factors and details of the reference patient populations are included within the guideline. Additional information is available at www.asco.org/melanoma-guidelines and www.asco.org/guidelineswiki .

3 Guideline Sentinel Lymph Node Biopsy and Management of Regional Lymph Nodes in Melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Clinical Practice Guideline Update Summary. 2018

Wong, Sandra L / Kennedy, Erin B / Lyman, Gary H. ·Dartmouth-Hitchcock Medical Center, Lebanon, NH; American Society for Clinical Oncology, Alexandria, VA; and Fred Hutchinson Cancer Research Center, Seattle, WA. ·J Oncol Pract · Pubmed #29232158.

ABSTRACT: -- No abstract --

4 Guideline Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology joint clinical practice guideline. 2012

Wong, Sandra L / Balch, Charles M / Hurley, Patricia / Agarwala, Sanjiv S / Akhurst, Timothy J / Cochran, Alistair / Cormier, Janice N / Gorman, Mark / Kim, Theodore Y / McMasters, Kelly M / Noyes, R Dirk / Schuchter, Lynn M / Valsecchi, Matias E / Weaver, Donald L / Lyman, Gary H / Anonymous1300731 / Anonymous1310731. ·University of Michigan, Ann Arbor, MI, USA. ·J Clin Oncol · Pubmed #22778321.

ABSTRACT: PURPOSE: The American Society of Clinical Oncology (ASCO) and Society of Surgical Oncology (SSO) sought to provide an evidence-based guideline on the use of lymphatic mapping and sentinel lymph node (SLN) biopsy in staging patients with newly diagnosed melanoma. METHODS: A comprehensive systematic review of the literature published from January 1990 through August 2011 was completed using MEDLINE and EMBASE. Abstracts from ASCO and SSO annual meetings were included in the evidence review. An Expert Panel was convened to review the evidence and develop guideline recommendations. RESULTS: Seventy-three studies met full eligibility criteria. The evidence review demonstrated that SLN biopsy is an acceptable method for lymph node staging of most patients with newly diagnosed melanoma. RECOMMENDATIONS: SLN biopsy is recommended for patients with intermediate-thickness melanomas (Breslow thickness, 1 to 4 mm) of any anatomic site; use of SLN biopsy in this population provides accurate staging. Although there are few studies focusing on patients with thick melanomas (T4; Breslow thickness, > 4 mm), SLN biopsy may be recommended for staging purposes and to facilitate regional disease control. There is insufficient evidence to support routine SLN biopsy for patients with thin melanomas (T1; Breslow thickness, < 1 mm), although it may be considered in selected patients with high-risk features when staging benefits outweigh risks of the procedure. Completion lymph node dissection (CLND) is recommended for all patients with a positive SLN biopsy and achieves good regional disease control. Whether CLND after a positive SLN biopsy improves survival is the subject of the ongoing Multicenter Selective Lymphadenectomy Trial II.

5 Guideline Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology joint clinical practice guideline. 2012

Wong, Sandra L / Balch, Charles M / Hurley, Patricia / Agarwala, Sanjiv S / Akhurst, Timothy J / Cochran, Alistair / Cormier, Janice N / Gorman, Mark / Kim, Theodore Y / McMasters, Kelly M / Noyes, R Dirk / Schuchter, Lynn M / Valsecchi, Matias E / Weaver, Donald L / Lyman, Gary H / Anonymous11110730 / Anonymous11120730. ·University of Michigan, Ann Arbor, MI, USA. ·Ann Surg Oncol · Pubmed #22766987.

ABSTRACT: PURPOSE: The American Society of Clinical Oncology (ASCO) and Society of Surgical Oncology (SSO) sought to provide an evidence-based guideline on the use of lymphatic mapping and sentinel lymph node (SLN) biopsy in staging patients with newly diagnosed melanoma. METHODS: A comprehensive systematic review of the literature published from January 1990 through August 2011 was completed using MEDLINE and EMBASE. Abstracts from ASCO and SSO annual meetings were included in the evidence review. An Expert Panel was convened to review the evidence and develop guideline recommendations. RESULTS: Seventy-three studies met full eligibility criteria. The evidence review demonstrated that SLN biopsy is an acceptable method for lymph node staging of most patients with newly diagnosed melanoma. RECOMMENDATIONS: SLN biopsy is recommended for patients with intermediate-thickness melanomas (Breslow thickness, 1-4 mm) of any anatomic site; use of SLN biopsy in this population provides accurate staging. Although there are few studies focusing on patients with thick melanomas (T4; Breslow thickness, >4 mm), SLN biopsy may be recommended for staging purposes and to facilitate regional disease control. There is insufficient evidence to support routine SLN biopsy for patients with thin melanomas (T1; Breslow thickness, <1 mm), although it may be considered in selected patients with high-risk features when staging benefits outweigh risks of the procedure. Completion lymph node dissection (CLND) is recommended for all patients with a positive SLN biopsy and achieves good regional disease control. Whether CLND after a positive SLN biopsy improves survival is the subject of the ongoing Multicenter Selective Lymphadenectomy Trial II.

6 Editorial Melanoma Surveillance Strategies: Different Approaches to a Shared Goal. 2018

Shirai, Keisuke / Wong, Sandra L. ·Department of Medicine, The Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, USA. · Department of Surgery, The Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, USA. Sandra.L.Wong@hitchcock.org. ·Ann Surg Oncol · Pubmed #29294186.

ABSTRACT: -- No abstract --

7 Editorial Melanoma Surgery: Why Don't We Let the Guidelines Guide Practice? 2017

Kang, Ravinder / Wong, Sandra L. ·Department of Surgery, The Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. · Department of Surgery, The Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. Sandra.L.Wong@hitchcock.org. ·Ann Surg Oncol · Pubmed #28534078.

ABSTRACT: -- No abstract --

8 Editorial Micrometastases in sentinel lymph nodes: not getting lost in translation. 2012

Wong, Sandra L. · ·Ann Surg Oncol · Pubmed #22230944.

ABSTRACT: -- No abstract --

9 Review Surgical treatment options for stage IV melanoma. 2014

Wei, Iris H / Healy, Mark A / Wong, Sandra L. ·Department of Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA. · Department of Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA. Electronic address: wongsl@umich.edu. ·Surg Clin North Am · Pubmed #25245969.

ABSTRACT: Melanomas have unique tumor biology and unpredictable patterns of metastasis. Metastatic melanoma is classified based on the location of metastasis. Surgical resection of metastatic melanoma may be performed for curative or palliative intent. In carefully selected patients, there is a survival benefit to metastasectomy. Candidates for surgical resection generally have favorable prognostic factors. Targeted biologic therapies and immunomodulatory therapies are promising new treatments associated with improved progression-free and overall survival. In the setting of new, effective medical therapies, further study is needed to determine how best to combine nonsurgical and surgical treatments for stage IV melanoma.

10 Review Sentinel lymph node biopsy in melanoma: controversies and current guidelines. 2014

Durham, Alison B / Wong, Sandra L. ·Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA. ·Future Oncol · Pubmed #24559449.

ABSTRACT: Melanoma is a global health problem and the incidence of this disease is rising. While localized melanoma has an excellent prognosis, regional and distant disease is associated with much poorer outcomes. Optimal treatment for clinically localized melanoma requires surgical control of the primary site and accurate staging of the regional nodal basin with sentinel lymph node biopsy (SLNB). While further data are required to determine if SLNB is associated with a survival advantage, currently available data supports the use of SLNB for staging of appropriate patients and the procedure may offer benefits beyond staging. This article reviews current data that shapes guidelines regarding patient selection for SLNB in melanoma and highlights areas where performing this procedure remains controversial.

11 Review Intensity of follow-up after melanoma surgery. 2014

Scally, Christopher P / Wong, Sandra L. ·Department of Surgery, University of Michigan, Ann Arbor, MI, USA. ·Ann Surg Oncol · Pubmed #24114053.

ABSTRACT: This contemporary review of melanoma surveillance strategies seeks to help practitioners examine and improve their surveillance protocols based on the currently available data. In general, there is no definitive benefit from increased screening or more aggressive use of interval imaging. Low-intensity surveillance strategies do not appear to adversely affect patient outcomes and should be the preferred approach compared with high-intensity strategies for most melanoma patients. All surveillance programs should emphasize education in order to maximize the effectiveness of patient-based detection of recurrent disease.

12 Review Evidence-based clinical practice guidelines on the use of sentinel lymph node biopsy in melanoma. 2013

Sondak, Vernon K / Wong, Sandra L / Gershenwald, Jeffrey E / Thompson, John F. ·From the Department of Cutaneous Oncology, Moffitt Cancer Center, and Departments of Oncologic Sciences and Surgery, University of South Florida, Tampa, FL; Department of Surgery, University of Michigan Medical Center, Ann Arbor, MI; Departments of Surgical Oncology and Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX; Melanoma Institute Australia and the University of Sydney, Sydney, Australia. ·Am Soc Clin Oncol Educ Book · Pubmed #23714536.

ABSTRACT: Sentinel lymph node biopsy (SLNB) was introduced in 1992 to allow histopathologic evaluation of the "sentinel" node, that is, the first node along the lymphatic drainage pathway from the primary melanoma. This procedure has less risk of complications than a complete lymphadenectomy, and if the sentinel node is uninvolved by tumor the likelihood a complete lymphadenectomy would find metastatic disease in that nodal basin is very low. SLNB is now widely used worldwide in the staging of melanoma as well as breast and Merkel cell carcinomas. SLNB provides safe, reliable staging for patients with clinically node-negative melanomas 1 mm or greater in thickness, with an acceptably low rate of failure in the sentinel node-negative basin. Evidence-based guidelines jointly produced by ASCO and the Society of Surgical Oncology (SSO) recommend SLNB for patients with intermediate-thickness melanomas and also state that SLNB may be recommended for patients with thick melanomas. Major remaining areas of uncertainty include the indications for SLNB in patients with thin melanomas, pediatric patients, and patients with atypical melanocytic neoplasms; the optimal radiotracers and dyes for lymphatic mapping; and the necessity of complete lymphadenectomy in all sentinel node-positive patients.

13 Review Review of evidence-based support for pretreatment imaging in melanoma. 2009

Sabel, Michael S / Wong, Sandra L. ·University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan 48109, USA. msabel@med.umich.edu ·J Natl Compr Canc Netw · Pubmed #19401061.

ABSTRACT: When making a new diagnosis of melanoma, clinicians often obtain imaging studies to rule out clinically occult distant disease. These studies range from inexpensive tests, such as chest radiographs, to more expensive studies, such as PET/CT. The impetus for ordering these studies is usually the desire to identify potentially resectable distant disease, avoid surgery when curative resection is not possible, and assuage patient anxiety by showing that no evidence of distant disease is present. However, some detrimental aspects to these studies are less apparent, including cost and potential for false-positive findings. Although routine use seems reasonable, the true benefit of these studies depends on the probability of clinically occult disease being present, likelihood that disease will be detected with the available technology, and impact of earlier detection on outcome. Contrary to current practice patterns, available evidence suggests that preoperative imaging studies are associated with significant costs and minimal benefit in most patients with melanoma. This article reviews available literature on the role of pretreatment imaging in patients with newly diagnosed cutaneous melanoma.

14 Article Receipt of sentinel lymph node biopsy for thin melanoma is associated with distance traveled for care. 2019

Kang, Ravinder / Columbo, Jesse A / Trooboff, Spencer W / Servos, Mariah M / Goodney, Philip P / Wong, Sandra L. ·Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. · VA Outcomes Group, Veterans Health Association, White River Junction, Vermont. · The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire. · Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. ·J Surg Oncol · Pubmed #30508289.

ABSTRACT: BACKGROUND: Sentinel lymph node biopsy (SLNB) is not routinely recommended for thin melanoma. However, it is considered when high-risk features, clinicopathological, or sociodemographic, are present. It was our objective to evaluate the impact of travel distance on decision-making for SLNB in thin melanoma. METHODS: We used the National Cancer DataBase (1998-2011) to identified patients with thin melanoma (≤1 mm thickness). The primary exposure was distance traveled for care, categorized as short (<12.5 miles), intermediate (12.5-49.9 miles), or long (≥50 miles). The primary outcome was receipt of SLNB. RESULTS: We identified 21 124 cases of thin melanoma; 48.8%, 38.2%, and 13.0% traveled short, intermediate, and long distances, respectively. Overall, SLNB was performed in 32.8% of patients. Traveling farther was associated with a step-wise increase in the likelihood of undergoing a SLNB (P-trend < 0.001). Even after adjusting for patient, disease, and facility factors, we found that patients who traveled an intermediate distance were 18% more likely to undergo a SLNB (OR:1.18; 95%CI: 1.10,1.27), and those who traveled a long distance were 24% more likely (OR:1.24; 95%CI: 1.11,1.39) compared with those who traveled a short distance. CONCLUSIONS: The distance patients travel for surgical care appears to be an independent factor influencing the receipt of SLNB.

15 Article The Role of Completion Lymph Node Dissection for Sentinel Lymph Node-Positive Melanoma. 2019

Hieken, Tina J / Kane, John M / Wong, Sandra L. ·Department of Surgery, Mayo Clinic, Rochester, MN, USA. hieken.tina@mayo.edu. · Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA. · Department of Surgery, Geisel School of Medicine at Dartmouth, Hanover, NH, USA. ·Ann Surg Oncol · Pubmed #30284132.

ABSTRACT: PURPOSE AND METHODS: Completion lymph node dissection (CLND) for sentinel lymph node (SLN)-positive melanoma patients has been guideline-concordant standard of care since adoption of lymphatic mapping and SLN biopsy for the management of clinically node-negative melanoma patients more than 20 years ago. However, a trend for omission of CLND has been observed over the past decade, and we now have randomized, controlled clinical trial data to help guide treatment recommendations. Publication of these data prompted an American Society of Clinical Oncology-Society of Surgical Oncology 2018 clinical practice guideline update for these patients. RESULTS AND CONCLUSIONS: Systematic review of current evidence supports a selective, individualized approach to CLND for SLN-positive melanoma. For low-risk, low-volume micrometastatic disease, SLN biopsy may be both diagnostic and therapeutic, and close clinical follow-up with imaging or CLND are reasonable options for appropriately selected patients. For higher-risk patients, omission of CLND requires careful consideration of risks versus benefits, relevant histopathology, and individualized patient discussion. This should address patient comorbidities and life expectancy, the predicted likelihood of additional positive nodes, availability of imaging surveillance, likelihood of adherence to imaging and clinical follow-up, consequences of regional recurrence, and the prognostic value of complete nodal staging and its impact on adjuvant therapy recommendations or clinical trial participation. Data on long-term outcomes, cost, and patient-reported quality of life measures are not yet available.

16 Article The natural history of thin melanoma and the utility of sentinel lymph node biopsy. 2017

Durham, Alison B / Schwartz, Jennifer L / Lowe, Lori / Zhao, Lili / Johnson, Andrew G / Harms, Kelly L / Bichakjian, Christopher K / Orsini, Amy P / McLean, Scott A / Bradford, Carol R / Cohen, Mark S / Johnson, Timothy M / Sabel, Michael S / Wong, Sandra L. ·Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan. · Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan. · Department of Biostatistics, University of Michigan Health System, Ann Arbor, Michigan. · University of Michigan Medical School, Ann Arbor, Michigan. · Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan. · Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan. · Department of Surgery, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. ·J Surg Oncol · Pubmed #28715140.

ABSTRACT: BACKGROUND AND OBJECTIVES: Current literature may overestimate the risk of nodal metastasis from thin melanoma due to reporting of data only from lesions treated with SLNB. Our objective was to define the natural history of thin melanoma, assessing the likelihood of nodal disease, in order to guide selection for SLNB. METHODS: Retrospective review. The primary outcome was the rate of nodal disease. Clinicopathologic factors were evaluated to find associations with nodal disease. RESULTS: Five hundred and twelve lesions, follow up available for 488 (median: 48 months). Lesions treated with WLE/SLNB compared to WLE alone were more likely to have high-risk features. The rate of nodal disease was higher in the WLE/SLNB group (24 positive SLNB, five false-negative SLNB with nodal recurrence: 10.2%) compared to WLE alone (four nodal recurrences: 2.0%). Univariate analysis showed age ≤45, Breslow depth ≥0.85 mm, mitotic rate >1 mm CONCLUSIONS: SLNB for melanoma 0.75-0.99 mm should be considered in patients age ≤45, Breslow depth ≥0.85 mm, mitotic rate >1 mm

17 Article Lymph Node Ratio Is Less Prognostic in Melanoma When Minimum Node Retrieval Thresholds Are Not Met. 2017

Healy, Mark A / Reynolds, Evan / Banerjee, Mousumi / Wong, Sandra L. ·Department of Surgery, University of Michigan, Ann Arbor, MI, USA. healym@umich.edu. · Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA. healym@umich.edu. · Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA. · Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA. · Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. ·Ann Surg Oncol · Pubmed #27495278.

ABSTRACT: BACKGROUND: Lymph node ratio (LNR), positive nodes divided by nodes examined, has been proposed for prognostication in melanoma to mitigate problems with low node counts. However, it is unclear if LNR offers superior prognostication over total counts of positive nodes and nodes examined. Additionally, the prognostic value of LNR may change if a threshold number of nodes are examined. We evaluated whether LNR is more prognostic than positive nodes and nodes examined, and whether the prognostic value of LNR changes with minimum thresholds. METHODS: Using the National Cancer Data Base Participant User File, we identified 74,692 incident cases with nodal dissection during 2000-2006. We compared LNR versus counts of examined and positive nodes based on Harrell's C, a measure of predictive ability. We then stratified by total nodes examined: greater versus fewer than ten for axillary lymph node dissection (ALND) and greater versus fewer than five for inguinal lymph node dissection (ILND). RESULTS: Overall, LNR had a Harrell's C of 0.628 (95 % confidence interval [CI] 0.625-0.631). Examined and positive nodes were not significantly different from this, with a Harrell's C of 0.625 (95 % CI 0.621-0.630). In ALND, LNR had a Harrell's C of 0.626 (95 % CI 0.610-0.643) with ≥10 nodes versus 0.554 (95 % CI 0.551-0.558) < 10 nodes. In ILND, LNR had a Harrell's C of 0.679 (95 % CI 0.664-0.694) with ≥5 nodes versus C of 0.601 (95 % CI 0.595-0.606) < 5 nodes. CONCLUSIONS: LNR provides no prognostic superiority versus counts of examined and positive nodes. Moreover, the prognostic value of LNR diminishes when minimum node retrieval thresholds are not met.

18 Article Implications of age and conditional survival estimates for patients with melanoma. 2016

Banerjee, Mousumi / Lao, Christopher D / Wancata, Lauren M / Muenz, Daniel G / Haymart, Megan R / Wong, Sandra L. ·aDepartment of Biostatistics bDepartment of Medicine, Division of Hematology/Oncology cDepartment of Surgery dDepartment of Medicine, Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA. ·Melanoma Res · Pubmed #26479218.

ABSTRACT: Overall cancer incidence is decreasing, whereas melanoma cases are increasing. Conditional survival estimates offer a more accurate prognosis for patients the farther they are from time of diagnosis. The effect of age and stage on a melanoma patient's conditional survival estimate is unknown. Surveillance, Epidemiology, and End Results data were utilized to identify newly diagnosed cutaneous melanoma patients (N=95 041), from 1998 to 2005, with up to 12 years of follow-up. Estimates of disease-specific survival by stage and age were determined by Cox regression analysis and transformed to estimated conditional 5-year survival. Localized melanoma patients have an excellent 5-year survival at diagnosis and over subsequent years. For patients with localized and regional disease, an age effect is present for disease-specific mortality when comparing older patients (70-79 years) with younger patients (<30 years): hazard ratio (HR) for mortality 3.79 [95% confidence interval (CI) 3.01-4.84] and HR 2.36 (95% CI 1.93-2.91), respectively. No age effect difference is observed in disease-specific survival for advanced disease: HR 1.14 (95% CI 0.87-1.53). Over time, conditional survival estimates improve for older patients with localized and regional disease. This improvement is not seen in distant disease, neither is the age gradient. Disease-specific mortality and conditional survival for patients with localized and regional melanomas are initially impacted by older age, with effects dissipating over time. Age does not affect survival in patients with advanced disease. Understanding the conditional 5-year disease-specific survival of melanoma based on age and stage can help patients and physicians, informing decision-making about treatment and surveillance.

19 Article Sentinel Lymph Node Biopsy Use Among Melanoma Patients 75 Years of Age and Older. 2015

Sabel, Michael S / Kozminski, David / Griffith, Kent / Chang, Alfred E / Johnson, Timothy M / Wong, Sandra. ·Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA, msabel@med.umich.edu. ·Ann Surg Oncol · Pubmed #25834993.

ABSTRACT: INTRODUCTION: While SLN biopsy is recommended for melanoma ≥1 mm in depth, its use among the elderly population is more controversial. We reviewed our experience at the University of Michigan with melanoma patients ≥75 years of age. METHODS: A total of 952 melanoma patients ≥75 years of age from 1996 to 2011 were identified from our institutional review board-approved database. In addition to clinicopathologic features and outcome data, comorbidity data were collected to calculate the Charlson comorbidity index (CCI). Univariate and multivariate Cox regression analysis was performed to characterize predictors of outcome. Kaplan-Meier analysis was used to generate survival curves. RESULTS: Among 553 clinically node-negative patients with melanoma ≥1 mm in Breslow thickness, 213 had wide excision alone, whereas 340 had excision and SLN biopsy, with 83 (24 %) having a positive SLN. SLN biopsy was less likely with older age (p < 0.0001) and H&N location (p = 0.007), but not CCI. SLN involvement was associated with female gender [odds ratio (OR) 2.15, p = 0.009], Breslow thickness [OR 1.23/mm increase, p = 0.004], and satellitosis (OR 4.43, p = 0.004). Distant disease-specific survival was negatively associated with male gender (OR 1.5, p = 0.007), increasing age (OR 1.05/year, p < 0.001), increasing Breslow thickness (OR 1.07/year, p = 0.013), ulceration (OR 1.51, p = 0.004), a positive SLN (OR 2.61, p < 0.001), and not having a SLN biopsy (OR 1.72, p < 0.001). CCI did not predict worse disease-free or melanoma-specific survival. CONCLUSIONS: WLE and SLN biopsy was not only strongly prognostic, but compared with WLE alone was associated with improved outcome, even after factoring for age and comorbidities. If otherwise healthy, SLN biopsy should be strongly considered for this population.

20 Article Sentinel lymph node biopsy in melanoma: final results of MSLT-I. 2014

Durham, Alison B / Wong, Sandra L. ·Department of Dermatology, Ann Arbor, MI, USA. ·Future Oncol · Pubmed #24947251.

ABSTRACT: In 1994 an international randomized controlled clinical trial, MSLT-I, opened to study the utility of sentinel lymph node biopsy (SLNB) for patients with clinically localized melanoma. This trial compared outcomes of patients treated with wide local excision (WLE) and SLNB (followed by immediate completion lymph node dissection [CLND] for those with a positive sentinel node [SN]) with outcomes of patients treated with WLE alone and CLND upon the development of clinically apparent disease. In February 2014 the final analysis of long-term outcomes data was published. Importantly, these data showed that the rates of nodal positivity were the same between the two arms of the trial. Although no difference in 10-year melanoma-specific survival was noted between the two arms, this was not entirely surprising as the overall rate of nodal disease within the trial was 20.8%, meaning that 79.2% of patients could not derive a benefit from SLNB. Subset analysis was performed to determine the impact of early intervention for those patients most likely to have a benefit from early detection. This analysis showed that for patients with nodal disease and intermediate-thickness melanoma (defined as 1.2-3.5-mm Breslow depth), early treatment following positive SLNB was associated with improved 10-year distant disease-free survival and improved 10-year melanoma-specific survival.

21 Article Discordance in histopathologic evaluation of melanoma sentinel lymph node biopsy with clinical follow-up: results from a prospectively collected database. 2014

Dandekar, Monisha / Lowe, Lori / Fullen, Douglas R / Johnson, Timothy M / Sabel, Michael S / Wong, Sandra L / Patel, Rajiv M. ·Department of Pathology, Tufts University School of Medicine, Boston, MA, USA. ·Ann Surg Oncol · Pubmed #24845727.

ABSTRACT: BACKGROUND: Sentinel lymph node (SLN) status currently represents the single most important prognostic factor in clinically localized melanoma and is widely used in patients with melanoma at significant risk for nodal micrometastasis. Although several studies have looked at the rates and implications of inaccuracies in the histopathologic diagnosis of melanocytic lesions, accuracy in the histologic interpretation of the SLN in melanoma has not been addressed. The goal of this study was to determine the rates of discordance in the histopathologic evaluation of the SLN and the potential clinical impact on patients referred to a comprehensive melanoma center. METHODS: A prospectively collected database was queried for melanoma patients who had SLN biopsies performed at outside institutions before referral to the University of Michigan Multidisciplinary Melanoma Program between 2006 and 2009. These cases were reviewed and clinical follow-up obtained. RESULTS: After internal review of the SLN material, 13 (8 %) of 167 cases had major discrepancies in diagnosis that impacted patient management and prognosis. The disease of five patients was subsequently downstaged and the disease of eight patients was upstaged after internal review of the SLNs and reversal in diagnoses. CONCLUSIONS: There appears to be a small yet significant rate of discordance in diagnosis of the SLN for melanoma after expert histopathologic review. The implications of this discordance and revision of diagnosis is substantial. Expert histopathologic review of the SLN warrants consideration to provide the most accurate prognostic information and optimal patient care.

22 Article Validation of statistical predictive models meant to select melanoma patients for sentinel lymph node biopsy. 2012

Sabel, Michael S / Rice, John D / Griffith, Kent A / Lowe, Lori / Wong, Sandra L / Chang, Alfred E / Johnson, Timothy M / Taylor, Jeremy M G. ·Department of Surgery, University of Michigan Health System, 3304 Cancer Center, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-0932, USA. msabel@umich.edu ·Ann Surg Oncol · Pubmed #21822550.

ABSTRACT: INTRODUCTION: To identify melanoma patients at sufficiently low risk of nodal metastases who could avoid sentinel lymph node biopsy (SLNB), several statistical models have been proposed based upon patient/tumor characteristics, including logistic regression, classification trees, random forests, and support vector machines. We sought to validate recently published models meant to predict sentinel node status. METHODS: We queried our comprehensive, prospectively collected melanoma database for consecutive melanoma patients undergoing SLNB. Prediction values were estimated based upon four published models, calculating the same reported metrics: negative predictive value (NPV), rate of negative predictions (RNP), and false-negative rate (FNR). RESULTS: Logistic regression performed comparably with our data when considering NPV (89.4 versus 93.6%); however, the model's specificity was not high enough to significantly reduce the rate of biopsies (SLN reduction rate of 2.9%). When applied to our data, the classification tree produced NPV and reduction in biopsy rates that were lower (87.7 versus 94.1 and 29.8 versus 14.3, respectively). Two published models could not be applied to our data due to model complexity and the use of proprietary software. CONCLUSIONS: Published models meant to reduce the SLNB rate among patients with melanoma either underperformed when applied to our larger dataset, or could not be validated. Differences in selection criteria and histopathologic interpretation likely resulted in underperformance. Statistical predictive models must be developed in a clinically applicable manner to allow for both validation and ultimately clinical utility.

23 Article Sentinel lymph node biopsy is accurate and prognostic in head and neck melanoma. 2012

Erman, Audrey B / Collar, Ryan M / Griffith, Kent A / Lowe, Lori / Sabel, Michael S / Bichakjian, Christopher K / Wong, Sandra L / McLean, Scott A / Rees, Riley S / Johnson, Timothy M / Bradford, Carol R. ·Department of Otolaryngology Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan 48109-5312, USA. ·Cancer · Pubmed #21773971.

ABSTRACT: BACKGROUND: Sentinel lymph node biopsy (SLNB) has emerged as a widely used staging procedure for cutaneous melanoma. However, debate remains around the accuracy and prognostic implications of SLNB for cutaneous melanoma arising in the head and neck, as previous reports have demonstrated inferior results to those in nonhead and neck regions. Through the largest single-institution series of head and neck melanoma patients, the authors set out to demonstrate that SLNB accuracy and prognostic value in the head and neck region are comparable to other sites. METHODS: A prospectively collected database was queried for cutaneous head and neck melanoma patients who underwent SLNB at the University of Michigan between 1997 and 2007. Primary endpoints included SLNB result, time to recurrence, site of recurrence, and date and cause of death. Multivariate models were constructed for analyses. RESULTS: Three hundred fifty-three patients were identified. A sentinel lymph node was identified in 352 of 353 patients (99.7%). Sixty-nine of the 353 (19.6%) patients had a positive SLNB. Seventeen of 68 patients (25%) undergoing completion lymphadenectomy after a positive SLNB result had at least 1 additional positive nonsentinel lymph node. Patients with local control and a negative SLNB failed regionally in 4.2% of cases. Multivariate analysis revealed positive SLNB status to be the most prognostic clinicopathologic predictor of poor outcome; hazard ratio was 4.23 for SLNB status and recurrence-free survival (P < .0001) and 3.33 for overall survival (P < .0001). CONCLUSIONS: SLNB is accurate and its results are of prognostic importance for head and neck melanoma patients.

24 Article Sentinel lymph node biopsy for melanoma: one procedure but many questions: comment on "Prognostic usefulness of sentinel lymph node biopsy for patients who have clinically node negative, localized, primary invasive cutaneous melanoma". 2011

Wong, Sandra L / Sabel, Michael S / Johnson, Timothy M. ·Department of Surgery, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor, MI 48109-0314, USA. ·Arch Dermatol · Pubmed #21482891.

ABSTRACT: -- No abstract --

25 Article Lymphatic mapping and sentinel lymph node biopsy in patients with melanoma: a meta-analysis. 2011

Valsecchi, Matias E / Silbermins, Damian / de Rosa, Nicole / Wong, Sandra L / Lyman, Gary H. ·Thomas Jefferson University, Philadelphia, PA, USA. ·J Clin Oncol · Pubmed #21383281.

ABSTRACT: PURPOSE: To perform a meta-analysis of all published studies of sentinel lymph node (SLN) biopsy for staging patients with melanoma. METHODS: Published literature in all languages between 1990 and 2009 was critically appraised. Primary outcomes evaluated included the proportion successfully mapped (PSM) and test performance including false-negative rate (FNR), post-test probability negative (PTPN), and positive predictive value in the same nodal basin recurrence. RESULTS: A total of 71 studies including 25,240 patients met full eligibility criteria. The average PSM was 98.1% (95% CI, 97.3% to 98.6%) and increased with the year of publication, female sex, ulceration, age, and the quality score of the studies. The FNR ranged from 0.0% to 34.0%, averaging 12.5% overall (95% CI, 11% to 14.2%). FNR increased with the length of follow-up (P = .002) but decreased with greater PSM (P = .001). PTPN averaged 3.4% (95% CI, 3.0% to 3.8%), which also increased in studies with longer follow-up, younger age, female sex, deeper Breslow thickness, and with tumor ulceration while decreasing with greater PSM (P < .001). Approximately 20% of the patients with a positive SLN had additional lymph nodes in the complete lymph node dissection and 7.5% of the patients with positive SLN developed recurrence in the same nodal basin which was greater in studies that also reported higher FNR (P = .01). CONCLUSION: The estimated risk of nodal recurrence after a negative SLN biopsy was ≤ 5% supporting the use of this technology for staging patients with melanoma.

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