A biópsia de linfonodo sentinela não deve ser recomendada para pacientes portadores de melanoma espesso

Filho, Renato Santos de Oliveira; Silva, Allisson Monteiro da; Oliveira, Daniel Arcuschin de; Oliveira, Gustavo G; Nahas, Fábio Xerfan

doi:10.1590/s0100-69912013000200008

Cited by 6 publications

(2 citation statements)

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“…SLNB for thick melanomas >4 mm in Breslow thickness has been questioned due to the poor prognosis and to the high risk of hematogenous dissemination in this subset of patients [ 47 , 48 , 49 ]. Oliveira Filho et al [ 48 ] found that regardless of the histopathological SLN status of thick melanomas, patients had similar rates of recurrence and mortality. According to such findings, SLNB may not be indicated for patients with thick melanomas [ 48 ].…”

Section: Management Of Regional Lymph Nodes: Sentinel Lymph Node Bmentioning

confidence: 99%

“…Oliveira Filho et al [ 48 ] found that regardless of the histopathological SLN status of thick melanomas, patients had similar rates of recurrence and mortality. According to such findings, SLNB may not be indicated for patients with thick melanomas [ 48 ]. In contrast, SLN status has been found to be the most important prognostic factor for survival and may serve as a useful tool to stratify patients in this high-risk group into adjuvant trials [ 31 , 50 ].…”

Section: Management Of Regional Lymph Nodes: Sentinel Lymph Node Bmentioning

confidence: 99%

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Update and Review on the Surgical Management of Primary Cutaneous Melanoma

et al. 2014

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The surgical management of malignant melanoma historically called for wide excision of skin and subcutaneous tissue for any given lesion, but has evolved to be rationally-based on pathological staging. Breslow and Clark independently described level and thickness as determinant in prognosis and margin of excision. The American Joint Committee of Cancer (AJCC) in 1988 combined features from each of these histologic classifications, generating a new system, which is continuously updated and improved. The National Comprehensive Cancer Network (NCCN) has also combined several large randomized prospective trials to generate current guidelines for melanoma excision as well. In this article, we reviewed: (1) Breslow and Clark classifications, AJCC and NCCN guidelines, the World Health Organization’s 1988 study, and the Intergroup Melanoma Surgical Trial; (2) Experimental use of Mohs surgery for in situ melanoma; and (3) Surgical margins and utility and indications for sentinel lymph node biopsy (SLNB) and lymphadenectomy. Current guidelines for the surgical management of a primary melanoma of the skin is based on Breslow microstaging and call for cutaneous margins of resection of 0.5 cm for MIS, 1.0 cm for melanomas ≤1.0 mm thick, 1–2 cm for melanoma thickness of 1.01–2 mm, 2 cm margins for melanoma thickness of 2.01–4 mm, and 2 cm margins for melanomas >4 mm thick. Although the role of SLNB, CLND, and TLND continue to be studied, current recommendations include SLNB for Stage IB (includes T1b lesions ≤1.0 with the adverse features of ulceration or ≥1 mitoses/mm2) and Stage II melanomas. CLND is recommended when sentinel nodes contain metastatic deposits.

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Section: Management Of Regional Lymph Nodes: Sentinel Lymph Node Bmentioning

confidence: 99%

Section: Management Of Regional Lymph Nodes: Sentinel Lymph Node Bmentioning

confidence: 99%

Update and Review on the Surgical Management of Primary Cutaneous Melanoma

et al. 2014

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Sentinel lymph node biopsy is indicated for patients with thick clinically lymph node‐negative melanoma

Yamamoto

Fisher

Wong

et al. 2015

Cancer

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BACKGROUND Sentinel lymph node biopsy (SLNB) is indicated for the staging of clinically lymph node-negative melanoma of intermediate thickness, but its use is controversial in patients with thick melanoma. METHODS From 2002 to 2012, patients with melanoma measuring ≥4 mm in thickness were evaluated at a single institution. Associations between survival and clinicopathologic characteristics were explored. RESULTS Of 571 patients with melanomas measuring ≥4 mm in thickness and no distant metastases, the median age was 66 years and 401 patients (70.2%) were male. The median Breslow thickness was 6.2 mm; the predominant subtype was nodular (45.4%). SLNB was performed in 412 patients (72%) whereas 46 patients (8.1%) presented with clinically lymph node-positive disease and 113 patients (20%) did not undergo SLNB. A positive SLN was found in 161 of 412 patients (39.1%). For SLNB performed at the study institution, 14 patients with a negative SLNB developed disease recurrence in the mapped lymph node basin (false-negative rate, 12.3%). The median disease-specific survival (DSS), overall survival (OS), and recurrence-free survival (RFS) for the entire cohort were 62.1 months, 42.5 months, and 21.2 months, respectively. The DSS and OS for patients with a negative SLNB were 82.4 months and 53.4 months, respectively; 41.2 months and 34.7 months, respectively, for patients with positive SLNB; and 26.8 months and 22 months, respectively, for patients with clinically lymph node-positive disease (P<.0001). The median RFS was 32.4 months for patients who were SLNB negative, 14.3 months for patients who were SLNB positive, and 6.8 months for patients with clinically lymph node-positive disease (P<.0001). CONCLUSIONS With an acceptably low false-negative rate, patients with thick melanoma and a negative SLNB appear to have significantly prolonged RFS, DSS, and OS compared with those with a positive SLNB. Therefore, SLNB should be considered as indicated for patients with thick, clinically lymph node-negative melanoma.

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