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To improve classification of patients with rapidly progressive disease who may profit from adjuvant therapy with novel immune or targeted treatment modalities, a single\u2010center retrospective analysis was performed including all melanoma patients diagnosed with a positive SN at a university\u2010based skin cancer center over a 10\u2010year period (2002\u20132012) (96 of 419 patients). Sentinel node metastasis mitotic rate (SN\u2010MMR) and further histologic parameters were determined by blinded histological re\u2010evaluation and correlated with clinical follow\u2010up (overall [OS], melanoma\u2010specific [MSS], and disease\u2010free survival [DFS]). Median follow\u2010up was 53 months. In univariate analyses, SN tumor penetrative depth (TPD), maximum tumor diameter (MTD), number of positive SN, SN\u2010MMR and the S\u2010, Rotterdam, RDC, Hannover I and II classification systems correlated with OS, MSS and DFS. Multivariate Cox regression analyses showed that a binary classification system based only on the SN\u2010MMR (&lt;1 <jats:italic>vs<\/jats:italic>. \u22651 mitoses\/mm<jats:sup>2<\/jats:sup>) was the strongest independent prognostic indicator for all endpoints analyzed. Kaplan\u2010Meier analyses confirmed binary SN\u2010MMR to be superior to stratify patients into high\u2010 and low\u2010risk groups (45.45% <jats:italic>vs<\/jats:italic>. 87.92% 5\u2010yr MSS). The general prognostic validity of the published SN classification systems was confirmed. The novel SN\u2010MMR classification system may improve discrimination of patients with slowly and rapidly progressive disease. We therefore propose its implementation into clinical practice as the SN\u2010MMR can be easily and reliably determined in routine pathology reports. Its prognostic value for the selection of patients amenable to adjuvant therapies should be studied in clinical trials.<\/jats:p>","DOI":"10.1002\/ijc.30563","type":"journal-article","created":{"date-parts":[[2016,12,9]],"date-time":"2016-12-09T12:28:04Z","timestamp":1481286484000},"page":"1907-1917","source":"Crossref","is-referenced-by-count":10,"title":["Sentinel node metastasis mitotic rate (<scp>SN<\/scp>\u2010<scp>MMR<\/scp>) as a prognostic indicator of rapidly progressing disease in patients with sentinel node\u2010positive melanomas"],"prefix":"10.1002","volume":"140","author":[{"given":"Cornelia","family":"Baum","sequence":"first","affiliation":[{"name":"Department of Dermatology, Venereology and Allergology University Medical Center and Medical Faculty Mannheim, Heidelberg University Mannheim Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christel","family":"Weiss","sequence":"additional","affiliation":[{"name":"Department for Medical Statistics and Biomathematics Medical Faculty Mannheim, Heidelberg University Mannheim Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoffer","family":"Gebhardt","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Allergology University Medical Center and Medical Faculty Mannheim, Heidelberg University Mannheim Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jochen","family":"Utikal","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Allergology University Medical Center and Medical Faculty Mannheim, Heidelberg University Mannheim Germany"},{"name":"Skin Cancer Unit, German Cancer Research Center (DKFZ) Heidelberg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Marx","sequence":"additional","affiliation":[{"name":"Institute of Pathology, University Medical Center and Medical Faculty Mannheim, Heidelberg University Mannheim 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