Prognostic Value of Multiple Draining Lymph Node Basins in Melanoma: A Matched-Pair Analysis Based on the John Wayne Cancer Institute Experience

Abstract

BackgroundThe prognostic significance of multiple draining basins is controversial in melanoma because analyses have not adequately controlled for standard prognostic variables. We hypothesized that an analysis based on prognostically matched pairs of patients with multiple versus single drainage basins would clarify any independent role of basin number.Study designWe identified patients in our 40-year prospective database, who underwent preoperative lymphoscintigraphy, intraoperative sentinel node biopsy and wide local excision for cutaneous melanoma. Overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were compared in patients with multiple versus single drainage basins after matching by age, sex, Breslow depth, primary site, and stage at diagnosis.ResultsWe identified 274 patients with multibasin drainage and 1,413 patients with single draining lymph node basins. Matching yielded 259 pairs (226 trunk, 27 head/neck, 6 extremity). Among matched pairs, multibasin drainage did not affect rates of lymph node metastasis (p = 0.84), OS (p = 0.23), DSS (p = 0.53), overall recurrence (p = 0.65), locoregional recurrence (p = 0.58), or distant recurrence (p = 1.0). Multivariable analysis linked higher T stage, ulceration, older age, and lymph node positivity to decreased DSS (p < 0.01) and DFS (p < 0.001). Number of drainage basins was not significant on univariable or multivariable analysis.ConclusionThis analysis, the first to match for standard prognostic factors, suggests that multiplebasin drainage as identified by lymphoscintigraphy has no independent biological or prognostic significance in primary cutaneous melanoma.

Synchronous bilateral axillary sentinel lymph node metastases in a patient with truncal melanoma

“…1 Several studies have since refuted Sappey's work by showing cutaneous malignancies with multiple lymphatic basin drainage (MLBD) patterns, some crossing the midline. [2][3][4][5][6][7][8][9] Although MLBD is commonly seen in primary truncal melanomas, the occurrence of SLN metastasis in multiple lymphatic basins is not common. We report a case of synchronous positive bilateral axillary SLN metastasis in a patient with primary cutaneous melanoma on the posterior trunk and review what is known about SLNs in melanoma patients with MLBD.…”

Sentinel lymph node biopsy for cutaneous melanoma in a real life setting: analysis of 47 cases treated at a private clinic in Brazil

“…As lesões primárias que levaram à indicação de BLNS localizavam-se no tronco (26), membros inferiores (14), membros superiores (6) e cabeça e pescoço (2) (Tabela 1). A linfocintilografia pré-operatória permitiu a identificação da da base de drenagem linfonodal (BDL) em todos, exceto um paciente.…”

“…Entre os pares combinados, a BDL múltipla não afetou as taxas de sobrevida global de metástases LN, recorrência geral, recorrência loco-regional ou recorrência à distância. [26][27][28] Complicações A BLNS é um procedimento invasivo e não isento de riscos. Complicações e sequelas são muito menos comuns quando comparadas à dissecção completa de LN.…”

Sentinel Node Identification in Melanoma: Current Clinical Impact, New Emerging SPECT Radiotracers and Technological Advancements. An Update of the Last Decade

“…In cutaneous melanoma, the prognostic significance of multiple drainage basins is still unclear [ 61 ]. As recommended, SLNB is performed for each basin identified during lymphoscintigraphy [ 62 ].…”

“…The results showed that the number of drainage basins did not affect rates of SLN metastasis, OS, DSS, overall recurrence, locoregional recurrence, and distant recurrence. In conclusion, this study demonstrated that as identified by lymphoscintigraphy multiple basin drainage is not an independent biological or prognostic factor in primary cutaneous melanoma [ 61 ].…”