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J Am Acad Dermatol. 2018 May;78(5):935-941. doi: 10.1016/j.jaad.2017.11.041. Epub 2017 Dec 1.

Mitotic rate is associated with positive lymph nodes in patients with thin melanomas.

Author information

1
Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee.
2
Department of Surgery, Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
3
Department of Surgery, Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: rondi.m.kauffmann@vanderbilt.edu.

Abstract

BACKGROUND:

The American Joint Commission on Cancer will remove mitotic rate from its staging guidelines in 2018.

OBJECTIVE:

Using a large nationally representative cohort, we examined the association between mitotic rate and lymph node positivity among thin melanomas.

METHODS:

A total of 149,273 thin melanomas in the National Cancer Database were examined for their association of high-risk features of mitotic rate, ulceration, and Breslow depth with lymph node status.

RESULTS:

Among 17,204 patients with thin melanomas with data on Breslow depth, ulceration, and mitotic rate who underwent a lymph node biopsy, there was a strong linear relationship between odds of having a positive lymph node and mitotic rate (R2 = 0.96, P < .0001, β = 3.31). The odds of having a positive node increased by 19% with each 1-point increase in mitotic rate (odds ratio, 1.19; 95% confidence interval, 1.17-1.21). Cases with negative nodes had a mean mitotic rate of 1.54 plus or minus 2.07 mitoses/mm2 compared with 3.30 plus or minus 3.54 mitoses/mm2 for those with positive nodes (P < .0001).

LIMITATIONS:

The data collected do not allow for survival analyses.

CONCLUSIONS:

Mitotic rate was strongly associated with the odds of having a positive lymph node and should continue to be reported on pathology reports.

KEYWORDS:

clinical research; guidelines; melanoma; mitotic rate; skin cancer; staging

PMID:
29198779
PMCID:
PMC6519988
DOI:
10.1016/j.jaad.2017.11.041
[Indexed for MEDLINE]
Free PMC Article

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