Patients with lymphatic metastasis of cutaneous malignant melanoma benefit from sentinel lymphonodectomy and early excision of their nodal disease

Kretschmer, Lutz; Hilgers, Reinhard; Möhrle, Matthias; Balda, Bernd‐Rüdiger; Breuninger, Helmut; Konz, Birger; Kunte, Christian; Marsch, Wolfgang Ch.; Neumann, Christine; Starz, Hans

doi:10.1016/j.ejca.2003.07.003

Cited by 121 publications

(86 citation statements)

References 25 publications

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“…Hierzu liegen retrospektive Untersuchungen vor. So konnte in ei− ner retrospektiven Vergleichsstudie an 314 Patienten mit SLNB und 623 Patienten mit Lymphknotendissektion wegen des klini− schen/sonographischen Metastasenverdachtes gezeigt werden, dass die 3− und 5−Jahres−Überlebensraten für SLNB−Patienten signifikant günstiger ausfielen [8]. In einer retrospektiven Ver− gleichsuntersuchung an 283 SLNB−Patienten und 3514 Mela− nom−Patienten im Stadium I und II mit alleiniger Nachsorge er− gab sich für die SLN−positiven Fälle kein Überlebensvorteil [12].…”

Section: Ausblickunclassified

Sentinel-Lymph-Node-Biopsie beim malignen Melanom

Konrad¹,

Wollina²

2005

Akt Dermatol

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EinführungBei primär kutanem Melanom ist die komplette chirurgische Ex− zision des Tumors mit Sicherheitsabstand die Methode der Wahl. Um die Tumorausbreitung festzustellen werden ± falls möglich ± noch vor dem operativen Eingriff die Staginguntersu− chungen durchgeführt, vor allem die sonographische Untersu− chung regionärer Lymphknoten. Der regionäre Lymphknotensta− tus ist neben der Tumordicke einer der wichtigsten prognosti− schen Faktoren, da die regionären Lymphknoten mit Abstand am häufigsten Sitz der Erstmetastasen sind [14].Ein Teil der Patienten, die klinisch einem N0−Stadium entspre− chen, weisen schon Mikrometastasen in den regionären Lymph− knoten auf. Deshalb wurde über einen längeren Zeitraum die prophylaktische Ausräumung der dem Tumor zugehörigen Lymphknotenregion unter der Hypothese durchgeführt, hier− durch möglicherweise bei geringer Tumorlast eine weitere Streuung zu verhindern (vor allem bei Melanomen mit einer grö− ßeren Tumordicke). Die Ergebnisse der elektiven Lymphknoten− dissektion gaben über Jahrzehnte Anlass zu Diskussionen. Von der elektiven Lymphknotendissektion profitierten nur bestimm− te Patientengruppen [3].Von Morton et al. (1992) AbstractThe technique of sentinel lymph node biopsy (SLNB) is a tool for melanoma staging that has been established for tumours thicker than 1 mm. The procedure is minimal invasive with reduced risk compared with elective lymph node dissection. Nevertheless, contraindications and adverse effects have to be considered. In patients with a primary melanoma without evidence of spread− ing SLNB provides a more precise staging that also has an influ− ence on further therapeutic options. On the other hand, data on prognosis improvement by SLNB are yet not sufficient for final confirmation.

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Section: Ausblickunclassified

Sentinel-Lymph-Node-Biopsie beim malignen Melanom

Konrad¹,

Wollina²

2005

Akt Dermatol

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“…In patients with a unilateral recurrence, bilateral inguinal lymphadenectomy should be undertaken, as the incidence of occult contralateral metastases is high owing to cross over lymphatics at the base of the penis. Prophylactic lymphadenectomy in melanoma has not been shown to improve survival, although the procedure may be beneficial in certain population subgroups (14,15) . The UK guidelines for the management of cutaneous melanoma do not currently support routine prophylactic lymphadenectomy (16) .…”

Section: Sentinel Lymph Node Biopsy (Fig-2)mentioning

confidence: 99%

“…A recent report proposes a survival advantage for patients having lymphadenectomy for. micrometastatic disease (14) .…”

Section: Sentinel Lymph Node Biopsy (Fig-2)mentioning

confidence: 99%

Surgical Management of M etastatic groin lymphadenopathyRetrospective study of 50 Cases in Regional Cancer Center

Dasappa¹

2018

jmscr

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“…Data suggesting that these patients may benefit from early excision of their nodal metastases are available. 1,2 The presence or absence of micrometastasis in the sentinel lymph node is critical for decision making with regard to complete lymphadenectomy and stratification for adjuvant therapy trials.…”

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confidence: 99%

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

et al. 2009

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The optimal processing for the pathology of sentinel lymph nodes of patients with melanoma is still a matter of debate. We compared two protocols of sentinel lymph node processing, which were consecutively applied. For the first protocol, the sentinel lymph nodes were cut into 1-2 mm thick slices. From each slice, 12 microtome sections were stained (multiple slices protocol). For the second protocol, which is a modification of the recent European Organisation for Research and Treatment of Cancer protocol, the sentinel lymph nodes were bivalved. Five consecutive series of microtome sections, with gaps of 50 lm between them, were prepared from each cut surface (bivalving protocol). H&E and immunohistochemical staining were integral elements of both protocols. A total of 584 sentinel lymph nodes (1.8±0.9 per patient) were examined. The percentages of micrometastases (29 versus 27%) and of capsular naevi (13 versus 15%) detected were very similar for both protocols. As shown by multivariate logistic regression, Breslow thickness (P ¼ 0.003) and younger age (P ¼ 0.01) correlated with nodal metastasis. The type of histological preparation, ulceration and sex were not significant. The multiple slices protocol produced, on average, 4 paraffin blocks and 46 microtome sections per node. The bivalving protocol constantly produced 2 paraffin blocks and 42 microtome sections. For technical processing, the multiple slices protocol required, on average, 38 min per sentinel lymph node, whereas the bivalving protocol required 55 min. Both protocols yielded excellent detection rates with a similar amount of work being required on the part of the pathologist. Compared with the bivalving protocol, the multiple slices protocol was less labor intensive for the technical staff.

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Patients with lymphatic metastasis of cutaneous malignant melanoma benefit from sentinel lymphonodectomy and early excision of their nodal disease

Cited by 121 publications

References 25 publications

Sentinel-Lymph-Node-Biopsie beim malignen Melanom

Sentinel-Lymph-Node-Biopsie beim malignen Melanom

Surgical Management of M etastatic groin lymphadenopathyRetrospective study of 50 Cases in Regional Cancer Center

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

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