Clinical Considerations on Sentinel Node Biopsy in Melanoma from an Italian Multicentric Study on 1,313 Patients (SOLISM–IMI)

Abstract

Regression in the primary melanoma seems to be a protective factor from metastasis in the SLN. When correctly calculated, the SNB FN rate is 15-20%. Furthermore, the SNB is important to more precisely assess the prognosis of patients with melanoma.

Lymphatic drainage patterns of head and neck cutaneous melanoma: does primary melanoma site correlate with anatomic distribution of pathologically involved lymph nodes?

“…Furthermore, previous studies involving melanomas from all anatomic sites showed a statistically significant improvement in survival in patient with intermediate thickness melanomas (range, 1-4 mm), which suggests that some subgroups of patients may benefit from ELND 3,25,31 . Finally, despite the fact that sentinel lymph node biopsy (SLNB) has been adopted into clinical practice as reliable staging modality, there are lots of arguments against it, such as increased incidence of nodal (regional and in-transit) recurrence in sentinel lymph nodes (SLN) negative patients, possibility of false-negative results, difficult identification of SLN if they are located close to primary site, SLN found in multiple node fields in contrast to melanomas located on extremities which usually drain to only 1 field, SLN in parotid region which are often very small, may be difficult to find, and their removal may put the facial nerve at risk 8,10,12,15,16,29,36,37 . However, some authors reported that intraparotid SLN biopsy is a reliable, accurate, and safe procedure for staging cutaneous head and neck melanoma 23 .…”

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

“…In the presence of primary tumor ulceration, the sentinel lymph node was significantly more often positive than in the absence of ulceration [144,146,148,157].…”

“…Regression of the primary tumor either has not been correlated with sentinel lymph node positivity [144,165,166] or it has been correlated with lower sentinel lymph node positivity [148,167]. Primary tumor location plays no role in the indication for SLNB.…”

“…Systematic search of the literature de-novo: [144][145][146][147][148][149][150] Strength of consensus: 100 %…”

“…In this context, a limit of ≥ 1 mm for the indication for SLNB is often cited. However, the risk for a positive sentinel lymph node rises continuously with increasing thickness of the primary tumor [146,148,156,157]. In a meta-analysis of 34 studies, a tumor thickness of < 1 mm was associated with a positive sentinel lymph node in 5.6 % of patients, with values ranging from 0-14.3 % [150].…”