Standard and Nonstandard Applications of Sentinel Node‐guided Melanoma Surgery

Abstract

Identification and histologic study of the sentinel node (SN) is an acceptable, yet not firmly established, guide for treating intermediate-thickness melanoma. This study widens the range of applications of this technique. We included 97 patients with intermediate-thickness melanoma lesions or lesions for which there is no standard treatment. Fifty-six underwent preoperative lymphoscintigraphy, and all underwent intraoperative lymphatic mapping (IOLM) using blue dye, followed by frozen section study and total node processing by serial sections. Elective lymph node dissection was performed in cases of metastasis to the sentinel node or technical failures with high risk. Four categories were defined: (A) intermediate-thickness lesions (mean 2.27 mm) (n = 45); (B) thin lesions (mean 1.14 mm) with risk factors of regional failure (n = 27); (C) lesion thickness close to but more than 4 mm (n = 10); and (D) lesions of undetermined thickness (n = 15). Median follow-up was 30 months (range 13-51 months). Intraoperative lymphatic mapping successfully identified the sentinel node (SN) in 93% of basins explored. Metastases were detected in 11 SNs. There were three lymph basin recurrences in patients with previously negative SNs, all salvaged by therapeutic lymph basin dissection and are NED (no evidence of disease). Two SN(+) patients had systemic recurrences; one died of his disease, and the other is alive with disease. One SN(-) patient died NED owing to other cause. This technique spared 83% of category A patients from lymph node dissection. It allowed better staging and better decision making for treatment in categories B and D; and it prevented early regional recurrences in category C patients. Intraoperative lymphatic mapping with SN guidance is a novel, lo

Lymphatic Drainage to the Popliteal Basin in Distal Lower Extremity Malignant Melanoma

“…Of the 476 patients with stage IB or higher melanoma who underwent surgery in our unit between August 1, 1993 3 have been offered sentinel node biopsy with preoperative lymphoscintigraphy. Briefly, 2 to 3 mCi of technetium 99m-labeled nanocolloid (Nanocoll; Nycomed Amersham Sorin Srl, Milan, Italy) was injected intradermally in 4 to 6 sites around the biopsy scar or the primary lesion (0.1 mL per injection).…”

Micrometastasis of a Sentinel Lymph Node in Cutaneous Melanoma Is a Significant Prognostic Factor for Disease-Free Survival, Distant-Metastasis-Free Survival, and Overall Survival

“…[6][7][8] Sentinel lymph node biopsy permits the identification of patients with subclinical occult lymph node metastases without requiring that patients undergo a complete primary lymph node dissection. 6,7,[9][10][11][12] In the event that patients with melanoma have a positive sentinel lymph node histology, this represents an important prognostic factor. 13 In contrast, the absence of a metastasis in the sentinel node indicates that the entire lymph node station is tumor-free.…”

Prognostic Value of Sentinel Lymph Node Biopsy Compared with that of Breslow Thickness: Implications for Informed Consent in Patients with Invasive Melanoma

“…In patients with melanoma 4 mm thick or more, 18 studies reported a comparison of overall survival according to SLN status using crude survival rates (two studies), Kaplan-Meier analysis (eight studies), or multivariate Cox regression (eight studies). 13,15,16,[18][19][20][21][22][23][24]26,30,32,33,35,38 The two studies reporting crude survival found equal rates in both groups. Of the eight studies using Kaplan-Meier analysis, five found a significant survival advantage for SLNÀ patients, one found no significant difference between survival according to group, and two did not report a statistical comparison.…”

“…13,15,16,[18][19][20][21][22][23][24]26,30,32,33,35,38 The two studies reporting crude survival found equal rates in both groups. 13,15,16,[18][19][20][21][22][23][24]26,30,32,33,35,38 The two studies reporting crude survival found equal rates in both groups.…”