The role of sentinel lymph node biopsy in patients with thick melanoma. A single centre experience
ABSTRACT To evaluate the role, if any, of sentinel lymph node mapping (SLNM) with biopsy (SLNB) in patients with thick cutaneous melanoma.
Consecutive patients with thick (Breslow ≥4 mm) cutaneous melanoma, undergoing SLNB were identified from a departmental database comprising 550 patients in total from 2000 to 2010. Factors examined included demographic data, histological subtype, site and depth of lesion, percentage of positive SLNs, regional recurrence in the setting of a negative SLNB result (false-negative rate), complications, further lymphadenectomy, and follow-up (disease free and overall survival), where available.
Sixty-four eligible patients (37 men, 27 women) underwent primary excision and SLNM. Median patient age was 59 years (range 8-82 years). Mean Breslow depth was 7 mm (range 4-19 mm). Thirty melanomas were located on the limbs, 19 on the head and neck and 15 on the trunk. Twenty-three (35%) were ulcerated. Of the 57 patients who had a sentinel node identified, 18 (31%) had metastatic melanoma identified. The mean survival time for patients with a negative SLN was 79 months versus 18 months for those with a positive node. Patients with a negative SLN have a 5 year disease free survival of 79% versus 11% (p < 0.001) and an overall 5 year survival rate of 85% versus 32% when compared to node positive patients.
The status of the SLN is predictive of disease recurrence and overall survival in patients with a thick primary cutaneous melanoma. This modality should be employed, where applicable, in this cohort of patients.
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ABSTRACT: This article covers the multidisciplinary treatment of primary melanoma. Excision margins and the need for sentinel lymphadenectomy are mainly dictated by the Breslow thickness although exceptions to this dictum do exist. Interferon is the only FDA approved adjuvant therapy for high risk melanoma although its overall survival benefit is minimal. Trials examining different doses or duration of interferon therapy have not demonstrated any promising survival data so far. There have been several randomized vaccine trials for melanoma but none have shown an overall survival benefit. Research into T-cell regulation continues and will hopefully bring promise for the future of melanoma treatment.Surgical Clinics of North America 03/2009; 89(1):267-81, xi. DOI:10.1016/j.suc.2008.11.002 · 1.93 Impact Factor
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ABSTRACT: Sentinel lymph node biopsy (SNB) is a widely accepted procedure used to accurately stage patients with melanoma. Its value in patients with thick melanoma (Breslow thickness >4 mm) is reason for discussion because of the generally poor prognosis of these patients. The purpose of this study was to report on the incidence of SNB positivity in patients with thick melanoma and to analyze the prognostic value of SNB in these patients. The prospective database of 248 patients with cutaneous melanoma, who underwent SNB in the Maaslandhospital Sittard between January 1994 and August 2007, was reviewed and completed. In 31 patients, SNB was performed for a thick melanoma. We analyzed survival (Kaplan-Meier) and survival differences (log-rank) in this group. In 64.5% of the patients with a thick melanoma, the SNB was positive. In our patients, SNB result was the only predictor for overall survival in patients with a thick melanoma (P = 0.045). To be accurately informed about a patient's prognosis and to decide whether subsequent completion lymph node dissection is indicated, SNB should not be omitted in patients with a primary thick melanoma.World Journal of Surgery 09/2009; 33(11):2464-8. DOI:10.1007/s00268-009-0159-3 · 2.35 Impact Factor
Article: Melanoma: Workup and Surveillance[Show abstract] [Hide abstract]
ABSTRACT: There is no clear consensus on the best means of detecting melanoma, particularly recurrence of melanoma. Physical examination remains paramount, but other means have been recommended also. This article provides a survey of these means.Clinics in plastic surgery 01/2010; 37(1):55-63. DOI:10.1016/j.cps.2009.08.004 · 1.35 Impact Factor