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Clinical significance of intra-nodal naevi in sentinel node biopsies for malignant melanoma

      Abstract

      Background

      Intra-nodal naevi (INN) identified during assessment of a sentinel lymph node for melanoma are not an uncommon finding. Little is known about their clinical significance. Patients with INN are treated as sentinel node biopsy (SNB) negative currently. Our aim was to assess the significance of INN in patients who undergo SNB for melanoma.

      Methods

      353 melanoma patients who underwent a SNB between November 1999 and June 2012 were retrospectively analysed from a prospectively collected database. The patients were divided into SNB negative, INN, isolated tumour cells (ITC) and SNB positive groups. Outcome measures of nodal recurrence, distal recurrence and survival were used to assess the differences between the groups.

      Results

      203 patients were SNB negative, 103 were positive of which 13 had ITC, 47 had INN (13%). Overall median follow up was 2.3 years (range 0.1–14.1 years). Our data demonstrated a statistically significant survival benefit for patients who had an INN compared to the SNB positive and ITC group. INN patients also had significantly better nodal and regional recurrence compared to SNB positive patients. There was no difference between INN and SNB negative patients.

      Conclusion

      We have clinically demonstrated that patients with INN on SNB can be adequately treated as SNB negative patients.

      Keywords

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      References

        • Jensen J.L.
        • Correll R.W.
        Nevus cell aggregates in submandibular lymph nodes.
        Oral Surg Oral Med Oral Pathol. 1980; 50: 552-556
        • Carson K.F.
        • Wen D.R.
        • Li P.X.
        • et al.
        Nodal nevi and cutaneous melanomas.
        Am J Surg Pathol. 1996; 20: 834-840
        • Patterson J.W.
        Nevus cell aggregates in lymph nodes.
        Am J Clin Pathol. 2004; 121: 13-15
        • Biddle D.A.
        • Evans H.L.
        • Kemp B.L.
        • et al.
        Intraparenchymal nevus cell aggregates in lymph nodes: a possible diagnostic pitfall with malignant melanoma and carcinoma.
        Am J Surg Pathol. 2003; 27: 673-681
        • Ridolfi R.L.
        • Rosen P.P.
        • Thaler H.
        Nevus cell aggregates associated with lymph nodes: estimated frequency and clinical significance.
        Cancer. 1977; 39: 164-171
        • McCarthy S.W.
        • Palmer A.A.
        • Bale P.M.
        • Hirst E.
        Naevus cells in lymph nodes.
        Pathology. 1974; 6: 351-358
        • Johnson W.T.
        • Helwig E.B.
        Benign nevus cell in the capsule of lymph nodes.
        Cancer. 1969; 23: 747-753
        • Fontaine D.
        • Parkhill W.
        • Greer W.
        • Walsh N.
        Nevus cells in lymph nodes: an association with congenital cutaneous nevi.
        Am J Dermatopathol. 2002; 24: 1-5
        • Hart W.R.
        Primary nevus of a lymph node.
        Am J Clin Pathol. 1971; 55: 88-92
        • Gambichler T.
        • Scholl L.
        • Stücker M.
        • et al.
        Clinical characteristics and survival data of melanoma patients with nevus cell aggregates within sentinel lymph nodes.
        Am J Clin Pathol. 2013; 139: 566-573
        • Hara K.
        Melanocytic lesions in lymph nodes associated with congenital naevus.
        Histopathology. 1993; 23: 445-451
        • Holt J.B.
        • Sangueza O.P.
        • Levine E.A.
        • et al.
        Nodal melanocytic nevi in sentinel lymph nodes. Correlation with melanoma-associated cutaneous nevi.
        Am J Clin Pathol. 2004; 121: 58-63
        • Marsden J.R.
        • Newton-Bishop J.A.
        • Burrows L.
        • et al.
        Revised UK guidelines for the management of cutaneous melanoma 2010.
        J Plast Reconstr Aesthet Surg. 2010 Sep; 63: 1401-1419
        • Morton D.L.
        • Thompson J.F.
        • Cochran A.J.
        • et al.
        Final trial report of sentinel-node biopsy versus nodal observation in melanoma.
        N Engl J Med. 2014; 370: 599-609
        • Chakera A.H.
        • Hesse B.
        • Burak Z.
        • et al.
        EANM-EORTC general recommendations for sentinel node diagnostics in melanoma.
        Eur J Nucl Med Mol Imaging. 2009 Oct; 36: 1713-1742
        • Guggenheum M.
        • Dummer R.
        • Jung F.J.
        • et al.
        The influence of sentinel lymph node tumour burden on additional lymph node involvement and disease-free survival in cutaneous melanoma – a retrospective analysis of 392 cases.
        Br J Cancer. 2008; 98: 1922-1928
        • Carlson G.W.
        • Murray D.R.
        • Lyles R.H.
        • Staley C.A.
        • Hestley A.
        • Cohen C.
        The amount of metastatic melanoma in a sentinel lymph node: dose it have prognostic significance?.
        Ann Surg Oncol. 2003; 10: 575-581
        • Andreola S.
        • Clemente C.
        Nevus cells in axillary lymph nodes from radical mastectomy specimens.
        Pathol Res Pract. 1985; 179: 616-618
        • Lambert W.C.
        • Brodkin R.H.
        Nodal and subcutaneous cellular blue nevi. A pseudometastasizing pseudomelanoma.
        Arch Dermatol. 1984; 120: 367-370
        • Fisher C.J.
        • Hill S.
        • Millis R.R.
        Benign lymph node inclusions mimicking metastatic carcinoma.
        J Clin Pathol. 1994; 47: 245-247
        • Kossard S.
        • Wilkinson B.
        Small cell (naevoid) melanoma: a clinicopathologic study of 131 cases.
        Australas J Dermatol. 1997; 38: S54-S58
        • Zembowicz A.
        • McCusker M.
        • Chiarelli C.
        • et al.
        Morphological analysis of nevoid melanoma: a study of 20 cases with a review of the literature.
        Am J Dermatopathol. 2001; 23: 167-175
        • de Vries T.J.
        • Smeets M.
        • de Graaf R.
        • et al.
        Expression of gp100, MART-1, tyrosinase, and S100 in paraffin-embedded primary melanomas and locoregional, lymph node, and visceral metastases: implications for diagnosis and immunotherapy. A study conducted by the EORTC Melanoma Cooperative Group.
        J Pathol. 2001; 193: 13-20
        • Bichel P.
        • Ornsholt J.
        Benign nevus cells in the lymph nodes: an immunohistochemical study.
        APMIS. 1988; 96: 117-122
        • Tajima Y.
        • Aizawa M.
        Migration of nevus cells into the lymph nodes.
        Jpn J Cancer Clin. 1987; 33: 1811-1814
        • Piana S.
        • Tagliavini E.
        • Ragazzi M.
        • et al.
        Lymph node melanocytic nevi: pathogenesis and differential diagnoses, with special reference to p16 reactivity.
        Pathol Res Pract. 2015 May; 211: 381-388
        • Shenoy B.V.
        • Fort III, L.
        • Benjamin S.P.
        Malignant melanoma primary in lymph node. The case of a missing link.
        Am J Surg Pathol. 1987; 11: 140-146
        • Traube J.M.
        • Begum S.
        • Shi C.
        • Eshleman J.R.
        • Westra W.H.
        Benign nodal nevi frequently harbour the activating V600R BRAF mutation.
        Am J Surg Pathol. 2009; 33: 568-571