Sentinel lymph node micrometastasis may predict non‐sentinel involvement in cutaneous melanoma patients

Department of Surgical Oncology, Institute of Oncology, Ljubljana, Slovenia.
Journal of Surgical Oncology (Impact Factor: 2.84). 07/2008; 98(1):46-8. DOI: 10.1002/jso.21066
Source: PubMed

ABSTRACT Cutaneous melanoma patients with positive sentinel lymph node biopsy (SLNB) are being treated with completion lymph node dissection (CLND). The aim of our study was to determine the predictive value of sentinel lymph node (SLN) micrometastases (metastases less than 2 mm in diameter) in assessing further lymph node involvement in CLND.
Between 2001 and 2005, we performed 476 SLNB in patients with stages I and II melanoma; 74 had metastases in SLN. We evaluated retrospectively the metastases in SLN according to their size and number. The presence of additional metastases in non-sentinel lymph nodes after CLND was evaluated.
Thirty-nine patients had micrometastases, 22 of them were solitary, 3 were double, and 14 patients had multiple micrometastases in SLN. Out of 22 solitary micrometastases, no patient had additional metastases in non-sentinel lymph nodes. From 3 patients with double micrometastases, 1 patient had further metastases in non-sentinel lymph nodes after CLND. Out of 14 patients with multiple micrometastases, 2 had additional metastases in CLND.
No patient with a single SLN micrometastasis had further metastases after CLND in our series. CLND may not be beneficial after detecting a single micrometastasis in SLN.

  • Source
    Cell Biology International 06/2003; 27(6):449-450. DOI:10.1016/S1065-6995(03)00076-3 · 1.64 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to evaluate the micromorphometric Starz-classification in melanoma patients. The micromorphometric Starz-classification suggests that melanoma patients with a sentinel node metastasis invading no more than 0.3 mm (S-I) or 0.31 to 1.0 mm (S-II) below the capsular level can be spared further surgery, while invasion of the metastasis of more than 1.0 mm (S-III) implies a need for completion dissection. Seventy patients with sentinel node metastases were studied. Twenty patients with an S-I or S-II classification were spared further surgery and 50 S-III patients underwent completion dissection. The median follow-up time was 33 months. No lymph node recurrences were detected in the 20 S-I, II patients. Six of the 50 S-III patients (12%) had additional involved nodes in the dissection specimen. In these patients no recurrences developed in the cleared regional basins. Overall 3-year survival was 100% in the S-I, II patients and 80% in the S-III patients (P = 0.04). Three-year disease-free survival rates were 83% and 60%, respectively (P = 0.40). : This study suggests that further surgery is unnecessary in S-I and S-II patients, while it does seem prudent to carry out completion dissection in S-III patients. The distinct survival difference between the 2 groups of patients suggests that the S-classification also has prognostic implications.
    Annals of surgery 07/2009; 249(6):1003-7. DOI:10.1097/SLA.0b013e3181a77eba · 7.19 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Skin melanoma is one of the most malignant diseases with increasing incidence rate. Sentinel node biopsy (SNB) is very important for early detection of metastatic spread. The aim of the study was to analyze the first 40 patients with skin melanoma of 1 to 4 mm Breslow thickness when SNB was indicated. The patient characteristics, localization of the primary melanoma as well as histology grade were analyzed. SNB with intraoperative radiocolloid and methylene blue dye detection was performed. Complication rate after SNB was analyzed and seroma was found in 5% of the patients. The therapeutic node dissection was performed in 10 patients with positive sentinel biopsy. The follow-up lasted two years. In five patients the false negative SNB was defined after the mean time of 11 months and the therapeutic dissection was performed. SNB in melanoma patients is a useful diagnostic procedure. It is advised for melanoma of 1 to 4 mm Breslow thickness.
    Vojnosanitetski pregled. Military-medical and pharmaceutical review 08/2009; 66(8):657-62. DOI:10.2298/VSP0908657K · 0.27 Impact Factor
Show more