Clinical utilities and biological characteristics of melanoma sentinel lymph nodes

An estimated 73870 people will be diagnosed with melanoma in the United States in 2015,resulting in 9940 deaths.The majority of patients with cutaneous melanomas are cured with wide local excision.However,current evidence supports the use of sentinel lymph node biopsy(SLNB) given the 15%-20% of patients who harbor regional node metastasis.More importantly,the presence or absence of nodal micrometastases has been found to be the most important prognostic factor in earlystage melanoma,particularly in intermediate thickness melanoma.This review examines the development of SLNB for melanoma as a means to determine a patient's nodal status,the efficacy of SLNB in patients with melanoma,and the biology of melanoma metastatic to sentinel lymph nodes.Prospective randomized trials have guided the development of practice guidelines for use of SLNB for melanoma and have shown the prognostic value of SLNB.Given the rapidly advancing molecular and surgical technologies,the technical aspects of diagnosis,identification,and management of regional lymph nodes in melanoma continues to evolve and to improve.Additionally,there is ongoing research examining both the role of SLNB for specific clinical scenarios and the ways to identify patients who may benefit from completion lymphadenectomy for a positive SLN.Until further data provides sufficient evidence to alter national consensusbased guidelines,SLNB with completion lymphadenectomy remains the standard of care for clinically node-negative patients found to have a positive SLN.

Survival in men older than 75 years with low- and intermediate-grade prostate cancer managed with watchful waiting with active surveillance

Objective:Recent studies have reported the underuse of active surveillance or watchful wait-ing for low-risk prostate cancer in the United States.This study examined prostate cancer-specific and all-cause death in elderly patients older than 75 years with low-risk tumors managed with active treatment versus watchful waiting with active surveillance(WWAS).Methods:We performed survival analysis in a cohort of 18,599 men with low-risk tumors(early and localized tumors)who were 75 years or older at the time of prostate cancer diagnosis in the linked Surveillance,Epidemiology,and End Results(SEER)-Medicare database(from 1992 to 1998)and who were followed up through December 2003.WWAS was defined as having an-nual screening for prostate-specific antigen and/or digital rectal examination during the follow-up period.The risks of prostate cancer-specific and all-cause death were compared by Cox regression models.The propensity score matching technique was used to address potential selection bias.Results:In patients with well-differentiated(Gleason score 2-4)and localized disease,those managed with WWAS without delayed treatment had higher risk of all-cause death(hazard ratio 1.20,95%confidence interval 1.13-1.28)but a substantially lower risk of prostate cancer-specific death(hazard ratio 0.62,confidence interval 0.51-0.75)than patients undergoing active treatment.Patients managed with WWAS with delayed treatment had comparable mortality outcomes.Sensi-tivity analyses based on propensity score matching yielded similar results.Conclusion:In men older than 75 years with well-differentiated and localized prostate cancer,WWAS without delayed treatment had a lower risk of prostate cancer-specific death and compa-rable all-cause death as compared with active treatment.Those patients in whom treatment was delayed had comparable mortality outcomes.Our results support WWAS as an initial management option for older men with well-differentiated and localized prostate cancer.