The role of lymphatic mapping and sentinel node biopsy in the management of atypical and anomalous melanocytic lesions

ArticleinJournal of Cutaneous Pathology 37 Suppl 1(s1):54-9 · April 2010with6 Reads
DOI: 10.1111/j.1600-0560.2010.01509.x · Source: PubMed
Atypical and anomalous melanocytic lesions are tumors that cannot be determined by microscopy to be certainly benign or fully malignant. The malignant potential of these borderline lesions is unknown and logical determination of best therapy is challenging, in particular whether lymphatic mapping and sentinel node biopsy have a place in their management. Lesions that fall into this category include atypical Spitzoid lesions, atypical cellular blue nevi, combined nevi, deep penetrating nevi, ancient nevi, desmoplastic nevi, balloon cell nevi and proliferation nodules of congenital nevi. We report our experience managing patients with these problematic tumors and discuss our approaches to determining the true location of lesional cells in sentinel nodes. Cochran AJ, Binder S, Morton DL. The role of lymphatic mapping and sentinel node biopsy in the management of atypical and anomalous melanocytic lesions.
    • "8 Otherwise, Barnhill (2006) suggested a well-defined protocol for the rigorous evaluation of Spitzoid lesions according to histopathological, clinical , and ancillary features. 2 Cochran et al. (2010) recently observed that atypical Spitz tumours cannot be shown to be definitely benign on the basis of microscopic examination, but do not possess microscopic features that would allow their confident identification as fully malignant. 9 Because of this, the use of SLNB, as for melanoma staging, has Risk of lymph node metastasis in ASN In patients with ASN, the risk of lymph node metastasis has been widely reported, sometimes at rates higher than in cutaneous melanoma (Table 2). "
    [Show abstract] [Hide abstract] ABSTRACT: The aim of this study was to evaluate the incidence of lymph node metastases in patients with atypical Spitz nevi (ASN) after sentinel lymph node biopsy (SLNB) and during follow-up, and to assess the diagnostic value of the surgical procedure. At the National Cancer Institute of Naples, Italy, 40 patients with ASN underwent SLNB between 2003 and 2011. Medical records were reviewed and all slides of the primary tumours were retrieved, rendered separately, and assessed by four experienced dermatopathologists from two different academic institutions. Each member of the review panel assessed slides separately without recourse to medical notes and blinded to each others' diagnosis. All patients were treated with wide local excision and SLN biopsy according to the standard procedure. All cases were followed up to assess outcomes. The original diagnosis of ASN was confirmed in all 40 cases. No sentinel node positivity was recorded, and no patients developed nodal involvement during a median follow-up of 46 months (range 16-103). All patients were alive and without evidence of locoregional or distant relapse at time of review. In our experience, ASN were not associated with metastatic potential. Surgical staging procedures are not justified and careful clinical surveillance is adequate.
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