Aberrant lymphatic drainage and risk for melanoma recurrence after negative sentinel node biopsy in middle‐aged and older men

Kaveh, A; Seminara, Nicole; Barnes, Melynda; Berger, Aaron J.; Chen, Frank W.; Yao, Mike; Johnson, Denise; Parsa, Sean; Quon, Andrew; Swetter, Susan M.; Sunwoo, John B.

doi:10.1002/hed.24094

Cited by 16 publications

(18 citation statements)

References 45 publications

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“…Except for nodular melanoma, the significance of these variables in predicting recurrent disease in SLNB-negative melanoma patients was previously illustrated by several authors 17,19,20. O’Connell et al recently stated that nodular histologic subtype approached significance in predicting recurrence in SLNB negative melanoma patients 17.…”

Section: Discussionmentioning

confidence: 93%

“…Overall, it is expected that unfavorable tumor clinicopathologic characteristics should be more frequent in the SLNB-positive group 6,12,13,21. Previous publications on SLNB-negative patients revealed increasing Breslow thickness, ulceration, head and neck melanoma, and unexpected lymph drainage patterns to be predictors for distant recurrence 14–16,19,20. Unexpected or aberrant lymph drainage patterns are expected in head and neck melanomas more than melanomas located on the upper and lower extremity.…”

Section: Discussionmentioning

confidence: 99%

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Nodular Histologic Subtype and Ulceration are Tumor Factors Associated with High Risk of Recurrence in Sentinel Node-Negative Melanoma Patients

et al. 2016

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BackgroundSince its introduction, the sentinel lymph node biopsy (SLNB) has become the standard staging procedure in clinical node-negative melanoma patients. A negative SLNB, however, does not guarantee a recurrence-free survival. Insight into metastatic patterns and risk factors for recurrence in SLNB negative melanoma patients can provide patient tailored guidelines.MethodsData concerning melanoma patients who underwent SLNB between 1996 and 2015 in a single center were prospectively collected. Cox regression analyses were used to determine variables associated with overall recurrence and distant first site of recurrence in SLNB-negative patients.ResultsIn 668 patients, SLNBs were performed between 1996 and 2015. Of these patients, 50.4 % were male and 49.6 % female with a median age of 55.2 (range 5.7–88.8) years. Median Breslow thickness was 2.2 (range 0.3–20) mm. The SLNB was positive in 27.8 % of patients. Recurrence rates were 53.2 % in SLNB-positive and 17.9 % in SLNB-negative patients (p < 0.001). For SLNB-negative patients, the site of first recurrence was distant in 58.5 %. Melanoma located in the head and neck region (hazard ratio 4.88, p = 0.003) and increasing Breslow thickness (hazard ratio 1.15, p = 0.013) were predictive for distant first site of recurrence in SLNB-negative patients. SLNB-negative patients with a nodular melanoma and ulceration had a recurrence rate of 43.1 %; the site of recurrence was distant in 64 % of these patients.ConclusionsThe recurrence rates of SLNB-negative nodular ulcerative melanoma patients approach those of SLNB-positive patients. Stringent follow-up is recommended in this subset of patients.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Nodular Histologic Subtype and Ulceration are Tumor Factors Associated with High Risk of Recurrence in Sentinel Node-Negative Melanoma Patients

et al. 2016

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Section: Txmentioning

confidence: 99%

“…Drainage patterns can be discordant from predicted patterns, 3,4 and a single lesion can drain to multiple basins. [4][5][6][7] Unfortunately, these challenges have resulted in a relative paucity of research for SLN studies in patients with head and neck melanoma.Planar sentinel lymphoscintigraphy is a highly functional and sensitive test to demonstrate lymphatic channels, and to identify SLNs and nodes with microscopic nodal metastasis. It provides valuable information about individual lymphatic collectors reaching the SLN, dynamic arrival time of the radiotracer at the SLN, number of lymphatic collectors leaving the melanoma site, and relative intensity of lymph nodes; however, it lacks information about detailed anatomy that would be helpful in surgical planning and identifying sentinel nodes closer to the injection site due to blooming artifact.…”

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confidence: 99%

SPECT/CT: Looking Beyond Sentinel Lymph Node Identification for Improving Patient Outcomes

Sibley

Subramaniam

2017

Ann Surg Oncol

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TXSentinel lymph node (SLN) identification is required for accurate prognostication for patients with head and neck melanoma.1 In clinical practice, identifying SLNs can be challenging. This is particularly true for patients with head and neck melanomas, which are associated with higher rates of false negative biopsies.2 Additionally, the drainage pattern of the head and neck is complex. Drainage patterns can be discordant from predicted patterns, 3,4 and a single lesion can drain to multiple basins. [4][5][6][7] Unfortunately, these challenges have resulted in a relative paucity of research for SLN studies in patients with head and neck melanoma.Planar sentinel lymphoscintigraphy is a highly functional and sensitive test to demonstrate lymphatic channels, and to identify SLNs and nodes with microscopic nodal metastasis. It provides valuable information about individual lymphatic collectors reaching the SLN, dynamic arrival time of the radiotracer at the SLN, number of lymphatic collectors leaving the melanoma site, and relative intensity of lymph nodes; however, it lacks information about detailed anatomy that would be helpful in surgical planning and identifying sentinel nodes closer to the injection site due to blooming artifact. Single photon emission computed tomography/computed tomography (SPECT/CT) overcomes this disadvantage and provides high-resolution anatomic images to localize the SLNs and second-tier lymph nodes. It has been demonstrated that SPECT/CT not only increases detection of metastatic involvement 8 but has also been associated with significant cost reduction. 9Trinh and colleagues performed a retrospective review 10 of 118 patients undergoing an SLN biopsy for head and neck cutaneous melanoma, all of whom underwent a SPECT/CT. Patients were categorized into two groups: 1 those in whom SPECT/CT did not identify additional nodal basins; and 2 those in whom SPECT/CT did identify additional basins. Two radiologists interpreted all the imaging studies and answered questions regarding the utility of SPECT/CT in addition to planar imaging. SLNs were then identified on the basis of radioactivity and/or dye uptake, and biopsied. The surgeons performing the procedure answered a survey regarding the impact of SPECT/CT for the extent of SLN biopsy incision and utility in detecting the SLNs. Long-term outcomes were then described. Of the patients with positive lymph node disease, 10% (2/20) were missed by planar imaging alone. The survey results suggest that SPECT/CT influenced the extent of the incision and helped to localize a SLN close to the primary tumor. In addition, the study by Trinh et al. showed that the sites of locations of SLNs where SPECT/CT is most helpful are the supraclavicular and peri-parotid regions. SPECT/CT added little information in identifying new SLNs in other neck levels.The outcomes addressed in their study, including disease-free survival, overall survival, locoregional recurrence, and distant recurrence, are of utmost importance to patients and clinicians. It is important t...

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“…However, cutaneous melanoma tumors of the head and neck have shown higher rates of recurrence in SLN‐negative nodal basins compared to other anatomical regions, as well as low rates of SLN positivity compared to lesions of the trunk or extremities . SLN biopsy in patients with melanoma of the head and neck poses several unique challenges, as surgeons must navigate the complex lymphatic drainage system of this region while preserving critical neurovascular structures . The close proximity of the nodal basin to the primary tumor site may also cause difficulty in locating the SLN during lymphoscintigraphy, and additional imaging methods may be necessary to accurately visualize the area .…”

Section: Introductionmentioning

confidence: 99%

Performance of a 31‐gene expression profile test in cutaneous melanomas of the head and neck

et al. 2019

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Background We report the performance of a gene expression profile test to classify the recurrence risk of cutaneous melanoma tumors of the head and neck as low‐risk Class 1 or high‐risk Class 2. Methods Of note, 157 primary head and neck cutaneous melanoma tumors were identified. Survival analyses were performed using Kaplan‐Meier and Cox methods. Results Gene expression profile class and node status stratified tumors into significantly different 5‐year survival groups by Kaplan‐Meier method ( P < .0001 for all end points), and both were independent predictors of recurrence in multivariate analysis. Overall, 74% of distant metastases and 88% of melanoma‐specific deaths had Class 2 risk. Conclusion The gene expression profile test identifies cases at increased risk for metastasis and death independent of a clinically or pathologically negative nodal status, suggesting that incorporation of this molecular tool could improve clinical management of patients with head and neck cutaneous melanoma, especially in those with a negative sentinel lymph node biopsy.

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Aberrant lymphatic drainage and risk for melanoma recurrence after negative sentinel node biopsy in middle‐aged and older men

Abstract: Lymphatic drainage differing from expected patterns is associated with greater recurrence after negative SLNB in middle-aged and older men. © 2015 Wiley Periodicals, Inc. Head Neck 38: E754-E760, 2016.

Cited by 16 publications

References 45 publications

Nodular Histologic Subtype and Ulceration are Tumor Factors Associated with High Risk of Recurrence in Sentinel Node-Negative Melanoma Patients

Nodular Histologic Subtype and Ulceration are Tumor Factors Associated with High Risk of Recurrence in Sentinel Node-Negative Melanoma Patients

SPECT/CT: Looking Beyond Sentinel Lymph Node Identification for Improving Patient Outcomes

Performance of a 31‐gene expression profile test in cutaneous melanomas of the head and neck

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