Multi-Institutional Melanoma Lymphatic Mapping Experience: The Prognostic Value of Sentinel Lymph Node Status in 612 Stage I or II Melanoma Patients

Abstract

Purpose: To compare the effect of pathologic sentinel lymph node (SLN) status with that of other known prognostic factors on recurrence and survival in patients with stage I or II cutaneous melanoma.Patients and Methods: We reviewed the records of 612 patients with primary cutaneous melanoma who underwent lymphatic mapping and SLN biopsy between January 1991 and May 1995 to determine the effects of tumor thickness, ulceration, Clark level, location, sex, and SLN pathologic status on disease-free and disease-specific survival.Results: In the 580 patients in whom lymphatic mapping and SLN biopsy were successful, the SLN was positive by conventional histology in 85 patients (15%) but negative in 495 patients (85%). SLN status was the most significant prognostic factor with respect to diseasefree and disease-specific survival by univariate and multiple covariate analyses. Although tumor thickness and ulceration influenced survival in SLN-negative patients, they provided no additional prognostic information in SLN-positive patients.Conclusion: Lymphatic mapping and SLN biopsy is highly accurate in staging nodal basins at risk for regional metastases in primary melanoma patients and identifies those who may benefit from earlier lymphadenectomy. Furthermore, pathologic status of the SLN in these patients with clinically negative nodes is the most important prognostic factor for recurrence. The information from SLN biopsy is particularly helpful in establishing stratification criteria for future adjuvant trials. J Clin Oncol 17:976-983.

Tumor lymphangiogenesis predicts melanoma metastasis to sentinel lymph nodes

“…5 SLN biopsy is also commonly used to detect metastases in patients with primary melanoma. 4 It can be a challenge, however, to detect SLN metastases, as they are often microscopic, requiring examination of multiple SLN sections. Dissection of SLN can also result in mild to moderate degrees of lymphedema 17 or sensory morbidity.…”

“…4 A total of 45 consecutive patients underwent SLN biopsies, 27 were found to have SLNs that were free of melanoma metastases (mean age of 53.8 years; range 19-76 years; termed 'SLN-negative'), whereas the tumors were found to have metastasized to the SLN in the remaining 18 patients (mean age of 54 years; range 29-78 years; termed 'SLN-positive'). These two groups were otherwise similar, in terms of tumor histologic type, presence and degree of ulceration, anatomic site, signs of regression and peritumoral inflammation (Table 1).…”

“…In addition to a complete surgical excision with wide margins, patients with primary melanomas 41.0 mm thick undergo intraoperative lymphatic mapping and sentinel lymph node (SLN) biopsy to identify the first deposition of microscopic metastatic cells. 4 Among several prognostic parameters, tumor thickness is currently the most sensitive parameter for predicting the metastatic risk of cutaneous melanoma. However, the prognosis for individual melanoma patients is still difficult to determine, since thin melanomas can also develop into lethal metastases.…”

Sentinel node procedure in Ib cervical cancer: a preliminary series

“…The combination of preoperative lymphatic mapping with intraoperative probe detection is increasingly used to identify the sentinel node in melanoma, breast cancer, and in other malignancies such as penile and vulvar cancer. Different studies showed that the sentinel node detection is a highly accurate diagnostic procedure (Giuliano et al, 1994;DeHullu et al, 1998;Gershenwald et al, 1999;DeHullu et al, 2000). In contrary to superficial carcinoma the physiology of lymphatic drainage from the cervix is not yet well established.…”

Cutting a sentinel lymph node into slices is the optimal first step for examination of sentinel lymph nodes in melanoma patients

“…In clinical practice, the detection rates reported varied widely, between 14 and 33.8%. [3][4][5][6][7][8][9][10] This has to be attributed, at least to some extent, to differences in the processing of the sentinel lymph nodes for pathology. To provide comparability between different institutions, standardised pathological protocols are required.…”