Abstract
Aim
Metastases can occur in up to 15% of all melanoma patients with negative sentinel
lymph node examination (SN –). We retrospectively investigated the number of preoperatively
marked sentinel lymph nodes (SNs) with lymphoscintigraphy and effectively surgically
removed SNs in SN – patients with cutaneous melanoma ≥0.5 mm. Ratio of these parameters
was calculated and impact of this ratio as well as impact of scintigraphic appearance
time (SAT) on disease progression was studied.
Materials and methods
Data on 122 SN – patients — 70 women (58%), mean age 56.5 years — were analyzed. Mean
follow-up time was 58 months.
Results
Mean tumour thickness of all patients was 2.3 mm. In 51 patients (42%) the number
of SNs marked in lymphoscintigraphy was higher than excised in surgery, in 47 patients
(38%) the same number as marked was excised and in 24 patients (20%) a lower number
was marked than excised. Metastases occurred in 17 patients (14%) after a mean time
of 24.8 months. Mean tumour thickness (5.4 mm) was significantly higher in these patients
than in the other patients (p = 0.000). Ratio of marked and excised SNs had no influence on disease progression;
the only parameter influencing outcome was tumour thickness (p = 0.000). Short SAT was significantly associated with higher tumour thickness (p = 0.004).
Conclusion
Our study indicates that, in routine clinical practice, it suffices to harvest the
first SN, as the ratio of marked and excised SNs has no impact on disease progression.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Surgical OncologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Technical details of lymphatic mapping for early stage melanoma.Arch Surg. 1992; 127: 392-399
- Deutsche Leitlinie: Malignes Melanom.(2005)
- Meta-analysis of sentinel node positivity in thin melanoma (≤1 mm).J Clin Oncol. May 20 2008; 26 (abstract 20032)
- The risk of regional lymph node metastases in patients with melanoma less than 1.0 mm thick: recommendations for sentinel node biopsy.J Am Coll Surg. 2003; 197: 403-407
- Prognostic value of sentinel node biopsy in 327 prospective melanoma patients from a single institution.Eur J Surg Oncol. 2008; 34: 673-679
- Lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: therapeutic utility and implications of nodal microanatomy and molecular staging for improving the accuracy of detection of nodal micrometastases.Ann Surg. 2003; 238: 538-549
- Revised American Joint Committee on Cancer staging criteria accurately predict sentinel lymph node positivity in clinically node-negative melanoma patients.Ann Surg Oncol. 2003; 10: 569-574
- Sentinel lymph node biopsy for cutaneous melanoma: the Stanford experience, 1997–2004.Arch Dermatol. 2005; 141: 1016-1022
- Natural history of melanoma in 773 patients with tumor-negative sentinel lymph nodes.Ann Surg Oncol. 2007; 14: 1604-1611
- Patterns of first-recurrence and post-recurrence survival in patients with primary cutaneous melanoma after sentinel lymph node biopsy.Ann Surg Oncol. 2007; 14: 1934-1942
- Outcome of patients with melanoma and histologically negative sentinel lymph nodes: a one institutions’s experience.Oncology. 2007; 73: 401-406
- Patterns of recurrence following negative sentinel lymph node biopsy in 243 patients with stage I or II melanoma.J Clin Oncol. 1998; 16: 2253-2260
- Outcome of 846 cutaneous melanoma patients from a single center after a negative sentinel node biopsy.Ann Surg Oncol. 2005; 12: 429-439
- Patterns of recurrence after sentinel lymph node biopsy for cutaneous melanoma.Am J Surg. 2003; 186: 675-681
- What is a sentinel node and what is a false-negative sentinel node?.Ann Surg Oncol. 2004; 11: 169S-173S
- Procedure guideline for lymphoscintigraphy and use of intraoperative gamma probe for sentinel lymph node localization in melanoma of intermediate thickness 1.0.J Nucl Med. 2002; 43: 1414-1418
- Current practice and future directions in pathology and laboratory evaluation of the sentinel node.Ann Surg Oncol. 2001; 8 (13–17)
- Final version of the American joint committee on cancer staging system for cutaneous melanoma.J Clin Oncol. 2001; 19: 3635-3648
- Sentinel-node biopsy or nodal observation in melanoma.N Engl J Med. 2006; 355: 1307-1317
- Prediction of non-sentinel node status and outcome in sentinel node-positive melanoma patients.Eur J Surg Oncol. 2008; 34: 82-88
- The impact of lymphoscintigraphy technique on the outcome of sentinel node biopsy in 1,313 patients with cutaneous melanoma: an Italian multicentric study (SOLISM-IMI).J Nucl Med. 2006; 47: 234-241
- High positive sentinel node identification rate by EORTC melanoma group protocol. Prognostic indicators of metastatic pattern after sentinel node biopsy in melanoma.Eur J Cancer. 2006; 42: 372-380
- Pathologic review of negative sentinel lymph nodes in melanoma patients with regional recurrence: a clinicopathologic study of 1152 patients undergoing sentinel lymph node biopsy.Am J Surg Pathol. 2003; 27: 1197-1202
- An increased number of sentinel lymph nodes is associated with advanced Breslow depth and lymphovascular invasion in patients with primary melanoma.Ann Surg Oncol. 2009; 16: 948-952
- Age-related lymphatic dysfunction in melanoma patients.Ann Surg Oncol. 2009; 16: 1548-1552
- Slow dynamics of lymphoscintigraphic mapping is associated to the negativity of the sentinel node in melanoma patients.Ann Surg Oncol. 2008; 15: 2878-2886
- Sentinel lymph node biopsy in the management of patients with primary cutaneous melanoma: review of a large single-institutional experience with emphasis on recurrence.Ann Surg. 2001; 233: 250-258
Article info
Publication history
Accepted:
May 4,
2010
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
