Interval sentinel lymph nodes in patients with cutaneous melanoma: A single-institution study in Japan
Department of Dermatology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan. The Journal of Dermatology
(Impact Factor: 2.25).
07/2010; 37(7):629-34. DOI: 10.1111/j.1346-8138.2010.00856.x
Interval sentinel lymph nodes (ISLN) are defined as the lymph nodes located between the primary melanoma and anatomically well-defined lymph nodal basins. It was reported that the ISLN appeared to be at the same metastatic risk as sentinel lymph nodes (SLN) in the traditional nodal basins. This study aimed to examine the incidence and metastatic risk of the ISLN in melanoma patients. Between June of 1999 and December of 2008, 117 patients enrolled at Nagoya University Hospital underwent SLN biopsy for primary cutaneous melanoma with a Breslow thickness of at least 1.0 mm. Triple techniques with lymphoscintigraphy, blue dye injection and gamma probe were used for the biopsy except for 13 cases that underwent lymphoscintigraphy, ultrasonography and blue dye injection, but without gamma probe. Patients who had melanoma of the head and neck were excluded from this analysis. The SLN were identified in 253 nodal basins from 117 patients, and ISLN were found in six patients (5%). We recognized 41 (17%) SLN metastases in 246 conventional nodal basins and one (14%) in seven ISLN. Although ISLN were identified infrequently, the incidence of metastasis into the ISLN was similar to that into SLN in conventional nodal basins. It is therefore recommended that preoperative lymphoscintigraphy and intraoperative recognition of ISLN should be performed.
Available from: Ausilia Maria Manganoni
- "The incidence of metastatic intransit nodes was between 14% and 22%  . Interval nodes were more common in melanoma of the trunk than in those of the lower limbs  . Although this interval nodes positivity is uncommon, the literature has showed that in more than 85% of cases reported with a metastatic disease in the interval node, this is often the only site of nodal metastasis  . "
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ABSTRACT: Background. Recent studies have demonstrated that there exists a great variation in the lymphatic drainage in patients with malignant melanoma. Some patients have drainage to lymph nodes outside of conventional nodal basins. The lymph nodes that exist between a primary melanoma and its regional nodal basin are defined "interval nodes". Interval node occurs in a small minority of patients with forearm melanoma. We report our experience of the Melanoma Unit of University Hospital Spedali Civili Brescia, Italy. Methods. Lymphatic mapping using cutaneous lymphoscintigraphy (LS) has become a standard preoperative diagnostic procedure to locate the sentinel lymph nodes (SLNs) in cutaneous melanoma. We used LS to identify sentinel lymph nodes biopsy (SLNB) in 480 patients. Results. From over 2100 patients affected by cutaneous melanoma, we identified 2 interval nodes in 480 patients with SLNB . The melanomas were both located in the left forearm. The interval nodes were also both located in the left arm. Conclusion. The combination of preoperative LS and intraoperative hand-held gamma detecting probe plays a remarkable role in identifying these uncommon lymph node locations. Knowledge of the unusual drainage patterns will help to ensure the accuracy and the completeness of sentinel nodes identification.
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ABSTRACT: High-dose Interferon-α-2b (HD-IFN) is an adjuvant treatment for melanoma. However, clinical trials for HD-IFN have not been reported in acral melanoma (AM), the predominant subtype of cutaneous melanoma in Asian population.
Patients with resected high-risk (stage IIb-IIIc) AM were randomly assigned to a regimen of 4-week (arm A: 15 × 10(6)U/m(2)d1-5/w × 4w) or 1-year adjuvant HD-IFN (arm B: 15 × 10(6)U/m(2)d1-5/w × 4w+9 × 10(6)Utiw × 48w), respectively. The endpoints were relapse-free survival (RFS), overall survival (OS) and toxicities.
A total of 158 patients were enrolled in this study and 147 patients were eligible for survival analysis. With a median follow-up of 36.1 months, median RFS for arm A and arm B were 17.9 months and 22.5 months, respectively (P=0.72). Stratified analysis showed that RFS curves of patients in stage IIIb-IIIc were statistically different between arm A and arm B (P=0.02). The median RFS of patients with more nodal metastases (n⩾3) was shorter (P=0.004) in arm A (3.3 months) than that in arm B (11.9 months). Grade 1/2 adverse effects were observed in both groups. However, patients in arm B showed higher incidence of reversible Grade 3/4 hepatotoxicity (P=0.03).
The induction dose of 15 × 10(6)U/m(2) and the maintenance dose of 9 × 10(6)U were tolerable, which may be the optional dose intensity for adjuvant IFN-α-2b therapy in Chinese high risk AM population. No statistical significance was detected in RFS between the 4-week and 1-year regimen while a 1-year regimen may show clinical benefits in patients with stage IIIb-IIIc AM or with ≥ 3 nodal metastases.
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DAV-interferon (IFN)-β therapy is a combination chemotherapy of dacarbazine (DTIC), nimustine (ACNU) and vincristine (VCR) with local subcutaneous injection of IFN-β that is widely employed as postoperative adjuvant chemotherapy to treat malignant melanoma in Japan. However, the efficacy of DAV-IFN-β therapy has not been confirmed by randomized controlled trials and the benefit of DAV-IFN-β therapy has not been established yet. This study evaluated the contribution of DAV-IFN-β therapy to improve survival of postoperative patients with cutaneous melanoma. Methods Patients with stage II or III cutaneous melanoma seen at Nagoya University Hospital from January 1998 to December 2009 were eligible for this study. Disease-free survival rates and melanoma-specific survival rates were evaluated. A propensity score was calculated to control for the effects of variables related to decisions regarding the application of DAV-IFN-β therapy.
Eighty-two stage II and 60 stage III melanoma patients were included. In the post-matched stage II patients (17 matched pairs), the mean (± SE) disease-free survival rates were 39.9 ± 13.7% for DAV-IFN-β therapy and 73.1 ± 11.7% for non-use (hazard ratio for recurrence, 2.06; 95% CI, 0.63-6.69; P = 0.23), and the melanoma-specific survival rates were 66.2 ± 20.0% for DAV-IFN-β therapy and 86.2 ± 9.1% for non-use (hazard ratio for death, 1.09; 95% CI, 0.17-6.82; P = 0.93). In the post-matched stage III patients (nine matched pairs), the disease-free survival rates were 29.6 ± 16.4% for DAV-IFN-β therapy and 33.3 ± 15.7% for non-use (0.69; 95% CI, 0.22-2.17; P = 0.53), and the melanoma-specific survival rates were 55.6 ± 16.6% for DAV-IFN-β therapy and 44.4 ± 16.6% for non-use (0.67; 95% CI, 0.18-2.50; P = 0.55).
DAV-IFN-β therapy brought no significant improvement in either disease-free survival rates or melanoma-specific survival rates of patients with stage II or III cutaneous melanoma. A randomized controlled trial would be required to further evaluate the efficacy of DAV-IFN-β therapy as an adjuvant chemotherapy.
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