Focused Ultrasound Surveillance of Lymph Nodes Following Lymphoscintigraphy Without Sentinel Node Biopsy: A Useful and Safe Strategy in Elderly or Frail Melanoma Patients

Ipenburg, Norbertus A.; Thompson, John F.; Uren, Roger F.; Chung, David; Nieweg, Omgo E.

doi:10.1245/s10434-019-07505-6

Cited by 13 publications

(5 citation statements)

References 34 publications

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“…The decision is likely not solely related to availability of the risk calculator, as it was used pre-nomogram. Ipenburg et al 7 reported use of this strategy for elderly patients and those with comorbidities, as the risks of complications from surgery are higher and the likelihood of nodal metastasis are less in the elderly. Observed patients who underwent therapeutic node dissection were noted to have significantly more involved nodes compared with SNpositive patients who underwent completion lymph node dissection.…”

Section: Discussionmentioning

confidence: 99%

“…One study found that patients undergoing ultrasound monitoring had similar rates of MSS, overall recurrence-free survival (RFS), and distant RFS as those managed with SLNB, however regional RFS was worse if SLNB was not performed. 7 To better stratify the risk of individual patients having SLN metastasis, the Memorial Sloan Kettering Cancer Center (MSKCC) published an SLN metastasis nomogram in 2005. 8 Subsequently, Melanoma Institute Australia (MIA) developed a refined risk calculator, made publicly available in August 2020 (www.…”

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confidence: 99%

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Impact of an Online Risk Calculator for Sentinel Node Positivity on Management of Patients with T1 and T2 Melanomas

Winder,

Boyer,

Ch’ng

et al. 2024

Ann Surg Oncol

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Background Predicting which patients with American Joint Committee on Cancer (AJCC) T1–T2 melanomas will have a positive sentinel lymph node (SLN) is challenging. Melanoma Institute Australia (MIA) developed an internationally validated SLN metastatic risk calculator. This study evaluated the nomogram’s impact on T1–T2 melanoma patient management at MIA. Methods SLN biopsy (SLNB) rates were compared for the pre- and post-nomogram periods of 1 July 2018–30 June 2019 and 1 August 2020–31 July 2021, respectively. Results Overall, 850 patients were identified (pre-nomogram, 383; post-nomogram, 467). SLNB was performed in 29.0% of patients in the pre-nomogram group and 34.5% in the post-nomogram group (p = 0.091). The overall positivity rate was 16.2% in the pre-nomogram group and 14.9% in the post-nomogram group (p = 0.223). SLNB was performed less frequently in T1a melanoma patients in the pre-nomogram group (1.1%, n = 2/177) than in the post-nomogram group (8.6%, n = 17/198) [p ≤ 0.001]. This increase was particularly for melanomas with a risk score ≥ 5%, with an SLN positivity rate of 11.8% in the post-nomogram group (p = 0.004) compared with zero. For T1b melanomas with a risk score of > 10%, the SLNB rate was 40.0% (8/20) pre-nomogram and 75.0% (12/16) post-nomogram (p = 0.049). Conclusions In this specialized center, the SLN risk calculator appears to influence practice for melanomas previously considered low risk for metastasis, with increased use of SLNB for T1a and higher-risk T1b melanomas. Further evaluation is required across broader practice settings. Melanoma management guidelines could be updated to incorporate the availability of nomograms to better select patients for SLNB than previous criteria.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Impact of an Online Risk Calculator for Sentinel Node Positivity on Management of Patients with T1 and T2 Melanomas

Winder,

Boyer,

Ch’ng

et al. 2024

Ann Surg Oncol

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“…Nodal ultrasonography is recommended only when SLNB has been declined or is not possible, 21 since ultrasonography has lower sensitivity and specificity when compared with SLNB. 22 Access to facilities was noted as a barrier to performing SLNB by some GPs based in regional and remote centres, and not all eligible patients are referred to clinicians who perform SLNB.…”

Section: Discussionmentioning

confidence: 99%

Australian general practitioners’ attitudes and knowledge of sentinel lymph node biopsy in melanoma management

Watts¹,

Smith²,

Robinson³

et al. 2020

Aust J Gen Pract

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Background and objective In Australia, the uptake of the sentinel lymph node biopsy (SLNB) appears low despite clinical practice guideline recommendations. The aim of this study was to describe the knowledge and attitudes of general practitioners (GPs) to SLNB. Methods GPs were recruited at an annual conference and a skin cancer skills workshop, and using GP professional communications. A mixed methods approach comprised a cross-sectional questionnaire and, for a subset of participants, semi-structured interviews. Results Overall, 231 GPs completed the questionnaire, of whom 23 were interviewed. One-third (32%) described themselves as quite or very familiar with the guidelines, and two-thirds (68%) thought that SLNB had an important role in the management of patients with melanoma. Of GPs who would discuss SLNB with eligible patients, <40% correctly identified that SLNB is recommended for patients with an invasive melanoma >1 mm thick. Conclusions GPs were generally supportive of SLNB. Familiarity with the guidelines was low, particularly regarding which patients should be considered for SLNB.

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“…Ipenburg [ 66 ] assessed TUS in melanoma patients who were older or had other health circumstances. In using lymphoscintigraphy and US without fine needle biopsy (FNB), 33% of nodal recurrences were detected before they became clinically apparent.…”

Section: Investigations Following Diagnosismentioning

confidence: 99%

Primary Cutaneous Melanoma—Management in 2024

Dixon,

Sladden,

Zouboulis

et al. 2024

JCM

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Background: Maximizing survival for patients with primary cutaneous melanomas (melanomas) depends on an early diagnosis and appropriate management. Several new drugs have been shown to improve survival in high-risk melanoma patients. Despite well-documented guidelines, many patients do not receive optimal management, particularly when considering patient age. Objective: to provide an update on melanoma management from the time of the decision to biopsy a suspicious skin lesion. Methods: We reviewed melanoma-management research published between 2018 and 2023 and identified where such findings impact and update the management of confirmed melanomas. Pubmed, Google Scholar, Ovid and Cochrane Library were used as search tools. Results: We identified 81 publications since 2017 that have changed melanoma management; 11 in 2018, 12 in 2019, 10 in 2020, 12 in 2021, 17 in 2022 and 18 in 2023. Discussion: Delayed or inaccurate diagnosis is more likely to occur when a partial shave or punch biopsy is used to obtain the histopathology. Wherever feasible, a local excision with a narrow margin should be the biopsy method of choice for a suspected melanoma. The Breslow thickness of the melanoma remains the single most important predictor of outcome, followed by patient age and then ulceration. The BAUSSS biomarker, (Breslow thickness, Age, Ulceration, Subtype, Sex and Site) provides a more accurate method of determining mortality risk than older currently employed approaches, including sentinel lymph node biopsy. Patients with metastatic melanomas and/or nodal disease should be considered for adjuvant drug therapy (ADT). Further, high-risk melanoma patients are increasingly considered for ADT, even without disease spread. Invasive melanomas less than 1 mm thick are usually managed with a radial excision margin of 10 mms of normal skin. If the thickness is 1 to 2 mm, select a radial margin of 10 to 20 mm. When the Breslow thickness is over 2 mm, a 20 mm clinical margin is usually undertaken. In situ melanomas are usually managed with a 5 to 10 mm margin or Mohs margin control surgery. Such wide excisions around a given melanoma is the only surgery that can be regarded as therapeutic and required. Patients who have had one melanoma are at increased risk of another melanoma. Ideal ongoing management includes regular lifelong skin checks. Total body photography should be considered if the patient has many naevi, especially when atypical/dysplastic naevi are identified. Targeted approaches to improve occupational or lifestyle exposure to ultraviolet light are important. Management also needs to include the consideration of vitamin D supplementary therapy.

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Focused Ultrasound Surveillance of Lymph Nodes Following Lymphoscintigraphy Without Sentinel Node Biopsy: A Useful and Safe Strategy in Elderly or Frail Melanoma Patients

Cited by 13 publications

References 34 publications

Impact of an Online Risk Calculator for Sentinel Node Positivity on Management of Patients with T1 and T2 Melanomas

Impact of an Online Risk Calculator for Sentinel Node Positivity on Management of Patients with T1 and T2 Melanomas

Australian general practitioners’ attitudes and knowledge of sentinel lymph node biopsy in melanoma management

Primary Cutaneous Melanoma—Management in 2024

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