TNM 8th edition: Sentinel Lymph Node Biopsy in stage T1b melanoma

TNM 8th edition: Sentinel Lymph Node Biopsy in stage T1b melanoma

Accepted Manuscript TNM 8th Edition: Sentinel Lymph Node Biopsy in Stage T1b Melanoma J. Smith, Registrar, C. Mcardle, Registrar, P. Stanley, Consulta...

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Accepted Manuscript TNM 8th Edition: Sentinel Lymph Node Biopsy in Stage T1b Melanoma J. Smith, Registrar, C. Mcardle, Registrar, P. Stanley, Consultant, P. Matteucci, Consultant PII:

S1748-6815(17)30150-X

DOI:

10.1016/j.bjps.2017.03.016

Reference:

PRAS 5285

To appear in:

Journal of Plastic, Reconstructive & Aesthetic Surgery

Received Date: 17 March 2017 Accepted Date: 21 March 2017

Please cite this article as: Smith J, Mcardle C, Stanley P, Matteucci P, TNM 8th Edition: Sentinel Lymph Node Biopsy in Stage T1b Melanoma, British Journal of Plastic Surgery (2017), doi: 10.1016/ j.bjps.2017.03.016. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

ACCEPTED MANUSCRIPT

Correspondence and communication:

TNM 8th Edition: Sentinel Lymph Node Biopsy in Stage T1b Melanoma

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J Smith1, C Mcardle2, P Stanley3, P Matteucci4

1. Registrar, Department of Plastic Surgery, Hull & East Yorkshire NHS Trust, Anlaby Road, HU3 2JZ

2. Registrar, Department of Plastic Surgery, Bradford Teaching Hospital NHS Foundation

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Trust, BD9 6RJ

3. Consultant, Department of Plastic Surgery, Hull & East Yorkshire NHS Trust, Anlaby

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Road, HU3 2JZ

4. Consultant, Department of Plastic Surgery, Hull & East Yorkshire NHS Trust, Anlaby Road, HU3 2JZ

Author for correspondence:

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J Smith

Department of Plastic Surgery, Hull & East Yorkshire NHS Trust, Anlaby Road, HU3 2JZ

Conflict of interest:

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None declared

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[email protected]

TNM 8th Edition: Sentinel Lymph Node Biopsy in Stage T1b Melanoma J Smith, C Mcardle, P Stanley, P Matteucci

ACCEPTED MANUSCRIPT Dear Sir, With the recent publication of TNM 8th Edition any Melanoma with a Breslow thickness (BT) <0.8mm has been reclassified as T1a regardless of the presence or absence of ul-

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ceration or mitotic rate[1]. The previous edition had stated that a T1a included any Melanoma with a BT of ≤ 1.0mm but upstaged to T1b with the presence of ulceration and/or mitotic rate ≥ 1/mm2. Whilst we await the results of MSLT II [3] many surgeons offer Sentinel Lymph Node Biopsy (SLNB) for all patients with staging T1b and higher and no evidence of macroscopic nodal disease. The authors note that a group of patients previously offered

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SLNB will now not routinely be included for the staging procedure. Taking this into consideration the authors wanted to identify this ‘lost’ group and whether they would be at risk of

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missed identifiable microscopic disease or whether the investigation had be unnecessary. A retrospective study of all patients undergoing SLNB for biopsy proven melanoma was performed between Feb 2010 and May 2016. Patients with a Melanoma BT of <0.8mm were identified for analysis. Data on patient demographics, tumour and SLNB location,

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Breslow thickness, lymph node biopsy result and all outpatient letters were collected. Three hundred and fifty patients underwent SLNB during the study period. Seventeen patients had TNM 7th stage T1b disease with a Breslow thickness of <0.8mm (4.8%) and presence of either ulceration or mitotic rate ≥ 1/mm2. The average BT was 0.55mm (0.2-

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0.73). Melanoma location included; 7 trunk, 3 arm , 5 leg , 1 head and neck, and 1 on the genitalia. SLNB location included; 9 axillae, 2 neck, 7 groin and 1 supraclavicular. All 17

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patients had negative SLNB. There is no evidence of metastatic disease to date in any patient. Average follow up is 818 days (116-2066days). No patients had complications related to their SLNB.

In our unit no patients with TNM 7th Stage T1b and BT <0.8mm demonstrated nodal or metastatic disease to date. This is reassuring given the recent down staging but highlights again the role that SLNB plays in patients with intermediate thickness melanoma.

Conflict of interest None

ACCEPTED MANUSCRIPT Funding None References

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1. Brierley JD, Gospodarowicz MK, Wittekind C. TNM Classification of Malignant Tumours, 8th Edition. Wiley-Blackwell. Dec 2016. ISBN: 978-1-119-26357-9

2. Sobin L, Gospodarowicz MK, Wittekind C. TNM Classification of Malignant Tumours, 7th Edition. Wiley-Blackwell. Dec 2009.

3. Morton D.L, Overview and Update of the Phase III Multicentre Selective Lymphadenec-

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tomy Trials (MSLT-I and MSLT-II). Clin Exp Metastasis. 2012 Oct; 29(7): 699-206.