Clinical Considerations on Sentinel Node Biopsy in Melanoma from an Italian Multicentric Study on 1,313 Patients (SOLISM–IMI)

Annals of Surgical Oncology (Impact Factor: 3.94). 07/2009; 16(7):2018-2027. DOI: 10.1245/s10434-008-0273-8

ABSTRACT BackgroundAlthough widely used for the management of patients with cutaneous melanoma, the sentinel lymph node (SLN) biopsy (SNB) procedure
raises several issues. This study was designed to investigate: the predictive factors of SLN status, the false-negative (FN)
rate, and patients’ prognosis after SNB.

Patients and MethodsThis is an observational, prospective study conducted on a large series of consecutive patients (n=1,313) enrolled by 23 Italian centers from 2000 through 2002. A commonly shared protocol was adopted for the SNB surgical
procedure and the SLN pathological examination.

ResultsThe SLN positive and false-negative (FN) rates were 16.9% and 14.4%, respectively (median follow-up, 4.5years). At multivariable
logistic regression analysis, the frequency of positive SLN increased with increasing Breslow thickness (p<0.0001) and decreased in patients with melanoma regression (p=0.024). At the multivariable Cox regression analysis, SLN status was the most important prognostic factor (hazards ratio
(HR)=3.08) for overall survival; the other statistically significant factors were sex, age, Breslow thickness, and Clark’s
level. Considering SLN and NSLN status, including FN cases, we identified four groups of patients with different prognoses.
The 5-year overall survival of patients with positive SLNs was 71.3% in those with negative nonsentinel lymph nodes (NSLNs)
and 50.4% if NSLNs were positive.

ConclusionsRegression in the primary melanoma seems to be a protective factor from metastasis in the SLN. When correctly calculated,
the SNB FN rate is 15–20%. Furthermore, the SNB is important to more precisely assess the prognosis of patients with melanoma.

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    ABSTRACT: Aim. The purpose of this study is to evaluate prognosis and surgical management of head and neck melanoma (HNM) and the accuracy of sentinel lymph node biopsy (SLNB). Patients and Methods. All patients with a primary cutaneous melanoma treated starting from 01/07/1994 to 31/12/2012 in the department of Plastic and Reconstructive Surgery of Bari are included in a electronic clinical medical registry. Within the 90th day from excision of the primary lesion all patients with adverse prognostic features underwent SLNB. All patients with positive findings underwent lymphadenectomy. Results. out of 680 patients affected by melanoma, 84 (12.35%) had HNM. In the HNM cohort lymphoscintigraphy was performed in 57 patients, 15 of which (26.3%) were positive. The percentage of unfound sentinel lymph node was similar both to the HNM group (5,26%) and to patients with melanoma of different sites (OMS 4,92%). There was a recurrence of disease after negative SLNB (false negatives) only in 4 cases. Recurrence-free period and survival rate at 5 years were worse in HNM cohort. Conclusion. SLNB of HNM has been for a long time contested due to its complex lymphatic anatomy, but recent studies agreed with this technique. Our experience showed that identification of sentinel lymph node in HNM cohort was possible in 98.25% of cases. Frequency of interval nodes is significantly higher in HNM group. The prognosis of HNM cohort is significantly shorter than OMS one. Finally, this procedure requires a multidisciplinary team in referral centers.