• Heidi Wat, Ambikaipakan Senthilselvan, and Thomas G Salopek.
• Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
• J. Am. Acad. Dermatol. 2016 Jan 1; 74 (1): 94-101.

BackgroundThere is a paucity of studies to substantiate whether the presence of a single mitosis justifies sentinel lymph node (SLN) biopsy (SLNB) in thin melanomas.ObjectiveWe sought to determine if mitotic rate is associated with SLNB outcome when taking into account other prognostic factors.MethodsAll cases of melanoma that underwent SLNB in the province of Alberta, Canada, between 2007 and 2013 were reviewed through a provincial tumor database.ResultsA total of 1072 patients fulfilled inclusion criteria. When analyzing all melanomas regardless of thickness, mitotic rate was a good predictor of SLN status. When stratified by Breslow thickness, only intermediate melanomas (1.01-2.0 mm) demonstrated a significant relationship between mitotic rate and positive SLN status (P = .010). For melanomas 1 mm or smaller, mitotic rate was not associated with SLN status. A statistically significant interaction was identified between Breslow thickness and mitotic rate such that for decreasing Breslow depth, the effect of mitotic rate on SLNB status diminished (P = .028).LimitationsThe study was retrospective in nature. There is underlying variability in mitotic rate reporting methods over time, and between different dermatopathologists.ConclusionsMitotic rate does not have unequivocal utility in predicting SLNB status in thin melanomas. There is a significant interaction between mitotic rate and Breslow depth, such that the predictive value of mitotic rate on SLN positivity may be dependent on Breslow thickness.Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

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