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Melanoma Sentinel Node Score Stratifies Risk

N-SNORE helps predict need for completion lymph node dissection

THURSDAY, Sept. 9 (HealthDay News) -- A weighted score of non-sentinel node (NSN) indices could predict which patients with sentinel node (SN)-positive melanoma could possibly be spared completion lymph node dissection (CLND), according to research published online Sept. 7 in the Journal of Clinical Oncology.

To analyze factors known to be predictive of NSN positivity, Rajmohan Murali, of the Royal Prince Alfred Hospital in Camperdown, Australia, and colleagues reviewed data from 409 patients with SN-positive melanoma, the majority of whom underwent CLND. The purpose of the study was to assess clinicopathologic factors that predict NSN positivity, which might, in turn, identify patients who could safely avoid CLND.

Primary tumor regression, proportion of harvested SNs involved by melanoma, sex, perinodal lymphatic invasion, and SN tumor burden indices were identified as factors independently predictive of NSN positivity. The sum of scores for these five characteristics was designated the N-SNORE; N-SNOREs were predictive of very low (0 percent), low (5 to 10 percent), intermediate (15 to 20 percent), high (40 to 50 percent), and very high (70 to 80 percent) risk of NSN positivity. The researchers concluded that, with further validation, N-SNORE might be useful in predicting those patients who could safely be spared CLND.

"Our results indicate that clinical and pathologic features of primary melanoma and SN tumor predict NSN positivity and that a simple weighted score (N-SNORE) derived from these parameters accurately stratifies risk of NSN involvement. N-SNORE has the potential for identifying patients at low risk for NSN positivity who may be safely spared CLND," the authors write.

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