Sentinel Lymph Node Biopsy for Sebaceous Cell Carcinoma and Melanoma of the Ocular Adnexa

Abstract

To provide clinical details and long-term outcome data for a series of patients with eyelid or conjunctival melanoma or eyelid sebaceous cell carcinoma who underwent sentinel lymph node (SLN) biopsy. Design: Retrospective interventional case series with review of clinical records and pathologic specimens. Setting: Tertiary comprehensive cancer center. Patients: Twenty-five consecutive patients treated at 1 institution for eyelid or conjunctival melanoma or eyelid sebaceous cell carcinoma from December 2000 to October 2004. Interventions: Surgical removal of the eyelid or conjunctival tumor and SLN biopsy. Main Outcome Measures: Local treatment modalities; lymphatic basins in which SLNs were identified; status of SLNs; false-negative rate; and long-term patterns of local recurrence, regional and distant metastasis, and survival. Results: Seven patients had conjunctival melanoma, 8 had eyelid-margin melanoma with a considerable palpebral conjunctival component, and 10 had eyelid sebaceous cell carcinoma. The SLNs were identified in all but 1 patient by using technetium Tc 99m sulfur colloid as a tracer. Intraoperatively, in 16 patients in whom blue dye was used in addition to technetium Tc 99m sulfur colloid during mapping, no SLN was blue. One patient with conjunctival melanoma and 1 patient with eyelid melanoma had a histologically positive SLN. Two patients with eyelid melanoma and 2 patients with eyelid sebaceous cell carcinoma had negative findings from SLN biopsy but developed recurrence in their regional lymph nodes during the follow-up period. Overall, during followup, 2 of 10 patients with sebaceous cell carcinoma (20%) and 5 of 15 patients with eyelid or conjunctival melanoma (33%) had regional lymph node metastasis. Four patients with melanoma who had regional metastasis also developed distant organ metastasis. Two patients with sebaceous cell carcinoma-1 with regional metastasis and 1 without-developed distant organ metastasis. Conclusions: The detection of histologically positive SLNs in this series of patients may justify further study of SLN biopsy for high-risk patients with ocular adnexal melanoma or eyelid sebaceous cell carcinoma. The false-negative rate is higher than that reported for SLN biopsy at most other anatomic sites. Patients with negative findings from SLN biopsy still require careful longterm follow-up because they may develop regional or distant metastasis.

Sentinel lymph node biopsy for ocular adnexal melanoma

“…False-negative events occurred in only 7% (3 of 51) of the patients in our series, and these false-negative events occurred only in the early years of our experience with SLNB for ocular adnexal melanoma (Ho et al 2007). We have had no false-negative events among patients who had SLNB in the past 10 years.…”

“…Adaptation of SLNB for ocular adnexal melanoma (eyelid and conjunctival melanoma) has been well established in the literature by our group and others (Esmaeli et al 2001;Wilson et al 2001;Ho et al 2007;Esmaeli 2008;Savar et al 2009). Sentinel lymph node biopsy (SLNB), a less invasive alternative to elective regional lymphadenectomy, is an effective method for detecting microscopic metastasis in regional lymph nodes.…”

“…Sentinel lymph node biopsy (SLNB), a less invasive alternative to elective regional lymphadenectomy, is an effective method for detecting microscopic metastasis in regional lymph nodes. Adaptation of SLNB for ocular adnexal melanoma (eyelid and conjunctival melanoma) has been well established in the literature by our group and others (Esmaeli et al 2001;Wilson et al 2001;Ho et al 2007;Esmaeli 2008;Savar et al 2009). This report is an update of our experience to date with SLNB for ocular adnexal melanoma at the University of Texas MD Anderson Cancer Center.…”

Sentinel Lymph Node Biopsy for Eyelid and Conjunctival Malignancy

“…Specifically for melanoma, some studies included tumor-thickness criteria, including tumor thickness of more than 2 mm, or the combination of Breslow thickness of more than 1 mm and Clark level IV or more, and the presence of ulceration. 15,21 Sentinel lymph node biopsy requires injection of a tracer substance around the periphery of the malignancy before the procedure to identify the draining lymph nodes. The type of tracer used for injection was named specifically in 18 of 27 articles, and it was technetium Tc99m-labeled sulfur colloid alone in 4 of 27 articles.…”

<p>Sentinel lymph node biopsy in the management of conjunctival melanoma: current insights</p>

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