Critical appraisal:Pawlik TM, Ross MI, Prieto VG, Ballo MT, Johnson MM, Mansfield PF, et al 2006

Critical Appraisal

Article being appraised

Pawlik TM, Ross MI, Prieto VG, Ballo MT, Johnson MM, Mansfield PF, et al. Assessment of the role of sentinel lymph node biopsy for primary cutaneous desmoplastic melanoma. Cancer 2006 Feb 15;106(4):900-6 Available from: http://www.ncbi.nlm.nih.gov/pubmed/16411225.

Applicable clinical question

• What is the optimal management for primary desmoplastic neurotropic melanomas?

Key Facts

Study Design

cohort study

Study aims:

1. To define the incidence of DM and evaluate the results of SLNB in patients with DM
2. To analyse the effect of DM histologic subtype (pure vs. mixed) on the incidence of positive SLNs at the time of selective lymphadenectomy

Number of Patients:

1850

Non DM: n=1785

Mixed DM: n=19

Pure DM: n=46

Reported outcome(s):

SLN Status
Characteristics Affecting Disease-Free Survival Rates
3-year acturial disease free survival

Results of outcome(s):

Univariate Analysis of Characteristics Affecting Disease-Free Survival Rates of 65 Patients with DM
- SLN pathologic status 0.02
- Radiation therapy: 0.18*

• Note that 20.0% of patients with DM (mixed DM, 5 of 19 [26.3%] vs. pure DM, 8 of 46 [17.4%]; P=0.41) received radiotherapy.
  

3-year acturial disease free survival
- Pure DM: 100%
- Non-DM: 90.5%
- Mixed DM: 78.2% (P=0.004 compared with patients with pure DM).

Includes an economic evaluation

no

Evidence ratings

Level of evidence

III-2

Risk of bias

High risk of bias

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Risk of bias assessment: cohort study

Subject selection

"New technology" group

Highly selected or not described

Comparison group

Highly selected or not described

Comparability of groups on demographic characteristics and clinical features

Not comparable but adjusted analysis used

Measurement of outcomes

Outcome measures blind to technology used

No, but objective measures used

Same method of measurement used across comparison groups

Yes

Completeness of follow-up

Was follow-up complete and were all patients included in the analysis?

Yes (follow-up >95%) or survival analysis using all patients

Result of appraisal

Included

Completed by

Meghna Kakani

This appraisal has been completed.

Article

Pawlik TM, Ross MI, Prieto VG, Ballo MT, Johnson MM, Mansfield PF, et al. Assessment of the role of sentinel lymph node biopsy for primary cutaneous desmoplastic melanoma. Cancer 2006 Feb 15;106(4):900-6 Available from: http://www.ncbi.nlm.nih.gov/pubmed/16411225.

Assigned to

User:Meghna.kakani

Topic area

Guidelines:Melanoma

Clinical question

• What is the optimal management for primary desmoplastic neurotropic melanomas?

Form

Form:Critical appraisal

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