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    Sentinel lymph node biopsy in patients with clinical stage IIB/C cutaneous melanoma: A national cohort study. Journal of the American Academy of Dermatology BACKGROUND:Approval of adjuvant anti-programmed cell death protein 1 therapy for pathologic stage IIB/C cutaneous melanoma has led some to question the role of sentinel lymph node (SLN) biopsy in the clinical stage IIB/C disease. OBJECTIVE:To determine the prognostic significance of SLN staging on disease-specific survival (DSS) for clinical stage IIB/C primary cutaneous melanoma in the preimmunotherapy era. METHODS:A retrospective cohort study was performed evaluating patients who underwent excision of clinical stage IIB/C cutaneous melanoma using the Surveillance, Epidemiology, and End Results database (2004-2011). Patients who did and did not undergo SLN biopsy were compared using propensity matching, and among those who underwent SLN biopsy, matched patients were further stratified by SLN status (SLN positive [SLN+] or SLN negative [SLN-]). RESULTS:Of the 8562 patients evaluated, 6021 (70.3%) underwent SLN biopsy. SLN positivity was associated with significantly reduced 5-year DSS among matched patients who underwent SLN biopsy (47.1% SLN+ vs 75.5% SLN-; P < .001). Five-year DSS remained significantly different across matched T-stages: T3b (54.2% SLN+ vs 64.8% SLN-; P = .004), T4a (55.5% SLN+ vs 71.6% SLN-; P = .001), and T4b (38.6% SLN+ vs 60.9% SLN-; P < .001). LIMITATIONS:Retrospective study. CONCLUSION:For patients with clinical stage IIB/C cutaneous melanoma, SLN status provides essential prognostic information. 10.1016/j.jaad.2022.04.025
    Melanoma with peripheral globules: clinical and dermoscopic features. Journal of the American Academy of Dermatology BACKGROUND:Morphology and biology of nevi with peripheral globules are well known, while that of melanomas with peripheral globules remain unclear. OBJECTIVE:Comparing the dermoscopic characteristics of nevi and melanomas with peripheral globules. METHODS:A total of 401 melanocytic lesions with peripheral globules were included in this retrospective study. Dermoscopic patterns and structures, including those of the peripheral globules, were evaluated. A generalized estimating equation model with a binomial distribution dependent variable and logit link function was fitted to the dataset to identify features with the highest odds for differentiating melanoma from nevi. RESULTS:Of the 401 lesions, 179 (44.64%) were excised, 41 (10.22%) of which were melanoma. Melanomas were most common in the lower extremities (P<0.01), with a disorganized pattern, whereas melanocytic nevi were most common on the trunk, with an organized pattern. The presence of blotches, atypical dots and globules, or atypical vessels was associated with melanomas (P<0.01). LIMITATIONS:The retrospective design of the study may have caused an inclusion bias. CONCLUSION:Melanocytic lesions displaying peripheral globules are at the greatest risk for melanoma if located on the lower extremity and if lesions reveal any of the following structures: blotch or atypical dots and globules or atypical vessels. 10.1016/j.jaad.2022.04.031
    Survival and Tumor Characteristics of Patients Presenting with Single Primary vs. Second Primary Melanoma Lesions. Journal of the American Academy of Dermatology BACKGROUND:Patients with single primary melanomas have an increased risk of developing subsequent melanomas. Secondary tumors diagnosed within and after three months are termed "synchronous" and "asynchronous," respectively. OBJECTIVE:Compare the tumor distributions and survival characteristics of patients with second primary melanoma subtypes to patients with single primary melanomas. METHODS:Retrospective cohort study. Data were collected from an institutional database from 14,029 patients with a diagnosis of a primary melanoma seen between 1970 and 2004. RESULTS:The synchronous and asynchronous cohorts demonstrated significantly improved survival probabilities compared to the single primary cohort (p=.04 and .002, respectively). Single primaries (2.2mm, SD=2.3) were significantly thicker than the first identified synchronous (2.0mm, SD=1.7) and the first identified asynchronous lesions (1.7mm, SD= 1.3). Synchronous lesions were more likely to be anatomically concordant compared to asynchronous lesions (55.7% vs 38.2%, p<.001). LIMITATIONS:Our limitations include the single center study design as well as incomplete records for second primary melanoma Breslow depth and histopathology. CONCLUSION:Patients with second primary melanomas demonstrated a significant survival advantage and thinner lesions compared to single primary melanomas. Our reported tumor distributions support the role of FBSE's, with attention to the region of initial diagnosis. 10.1016/j.jaad.2022.04.046