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Affiliation(s)
- Kelly M. McMasters
- Department of Surgery, University of Louisville School of Medicine, James Graham Brown Cancer Center, 550 S. Jackson St., Louisville, KY USA
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102
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Kingham TP, Panageas KS, Ariyan CE, Busam KJ, Brady MS, Coit DG. Outcome of patients with a positive sentinel lymph node who do not undergo completion lymphadenectomy. Ann Surg Oncol 2010; 17:514-20. [PMID: 19924486 DOI: 10.1245/s10434-009-0836-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Indexed: 02/05/2023]
Abstract
BACKGROUND Completion lymph node dissection (CLND), although considered a standard approach for patients with melanoma and a positive sentinel lymph node (SLN), is not performed in as many as 50% of indicated cases. This study evaluates the outcome of patients who had a positive SLN but did not undergo CLND at Memorial Sloan-Kettering Cancer Center. METHODS A prospective database was used to identify all patients with a positive SLN from 1992 to 2008. Patient and tumor characteristics, number of positive SLNs, recurrence pattern, reason for not performing a CLND, and current status were evaluated. RESULTS There were 2269 patients who underwent SLN biopsy. Three hundred thirteen had a positive SLN, of whom 271 (87%) had a CLND and 42 (13%) did not. Patients in the no-CLND group were older (median age 70 vs. 56 years, P < .01), and had a trend toward thicker melanomas (3.5 vs. 2.8 mm, P < .06). A significantly higher percentage of no- CLND patients had lower-extremity melanomas (40% vs. 13% CLND; P < .01). The most common reason for not performing a CLND was patient refusal (45%). There were similar rates and patterns of recurrence between the two groups. Recurrence-free survival and disease-specific survival were also similar between the groups. CONCLUSIONS It remains unclear whether CLND must be performed in all melanoma patients with a positive SLN. For selected informed patients who choose not to participate in the Multicenter Selective Lymphadenectomy Trial II trial, or in centers where the trial is not available, nodal observation may be an acceptable option.
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Affiliation(s)
- T Peter Kingham
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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103
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Stebbins WG, Garibyan L, Sober AJ. Sentinel lymph node biopsy and melanoma: 2010 update Part II. J Am Acad Dermatol 2010; 62:737-48;quiz 749-50. [PMID: 20398811 DOI: 10.1016/j.jaad.2009.11.696] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 11/11/2009] [Accepted: 11/16/2009] [Indexed: 11/19/2022]
Abstract
UNLABELLED This article will discuss the evidence for and against the therapeutic efficacy of early removal of potentially affected lymph nodes, morbidity associated with sentinel lymph node biopsy and completion lymphadenectomy, current guidelines regarding patient selection for sentinel lymph node biopsy, and the remaining questions that ongoing clinical trials are attempting to answer. The Sunbelt Melanoma Trial and the Multicenter Selective Lymphadenectomy Trials I and II will be discussed in detail. LEARNING OBJECTIVES At the completion of this learning activity, participants should be able to discuss the data regarding early surgical removal of lymph nodes and its effect on the overall survival of melanoma patients, be able to discuss the potential benefits and morbidity associated with complete lymph node dissection, and to summarize the ongoing trials aimed at addressing the question of therapeutic value of early surgical treatment of regional lymph nodes that may contain micrometastases.
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Affiliation(s)
- William G Stebbins
- Massachusetts General Hospital, Department of Dermatology, 55 Fruit St, Bartlett Hall 616, Boston, MA 02114, USA.
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104
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Sentinel node biopsy and standard of care for melanoma: A re-evaluation of the evidence. J Am Acad Dermatol 2010; 62:880-4. [DOI: 10.1016/j.jaad.2009.08.063] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Revised: 07/19/2009] [Accepted: 08/03/2009] [Indexed: 11/24/2022]
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105
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Sladden MJ, Foley P, Stanford DG, Zagarella S, Reid C. Sentinel node biopsy: not the standard of care for melanoma. J Am Acad Dermatol 2010; 62:708-9. [PMID: 20227586 DOI: 10.1016/j.jaad.2009.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 09/22/2009] [Accepted: 10/08/2009] [Indexed: 11/24/2022]
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106
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Early (sentinel lymph node biopsy-guided) versus delayed lymphadenectomy in melanoma patients with lymph node metastases. Cancer 2010; 116:1201-9. [DOI: 10.1002/cncr.24852] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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107
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108
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Sondak VK. Nonsentinel node metastases in melanoma: do they reflect the biology of the tumor, the lymph node or the surgeon? : Editorial to Accompany Ghaferi et al., ASO-2009-03-0312.R1. Ann Surg Oncol 2009; 16:2965-7. [PMID: 19669838 PMCID: PMC2766452 DOI: 10.1245/s10434-009-0667-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2009] [Accepted: 06/29/2009] [Indexed: 02/05/2023]
Affiliation(s)
- Vernon K. Sondak
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, FL USA
- Departments of Oncologic Sciences and Surgery, University of South Florida College of Medicine, Tampa, FL USA
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109
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Ghaferi AA, Wong SL, Johnson TM, Lowe L, Chang AE, Cimmino VM, Bradford CR, Rees RS, Sabel MS. Prognostic significance of a positive nonsentinel lymph node in cutaneous melanoma. Ann Surg Oncol 2009; 16:2978-84. [PMID: 19711133 DOI: 10.1245/s10434-009-0665-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 05/12/2009] [Accepted: 05/12/2009] [Indexed: 11/18/2022]
Abstract
PURPOSE Sentinel lymph node (SLN) biopsy provides important prognostic information for patients with cutaneous melanoma. There may be additional prognostic significance to melanoma spreading from the SLN to nonsentinel lymph nodes (NSLN). We examined the implications of a positive NSLN for overall and distant disease-free survival. METHODS Using a prospectively maintained, Institutional Review Board-approved melanoma database we studied patients who had a cutaneous melanoma, a positive SLN, and a completion lymph node dissection (CLND). Survival was determined using a combination of hospital records and the Social Security Death Index (SSDI). Univariate and multivariate Cox regression analysis was performed to further characterize predictors of overall and distant disease-free survival. Kaplan-Meier analysis was used to generate survival curves. RESULTS A total of 429 patients with positive SLN biopsies were identified, with at least one positive NSLN identified in 71 (17%). Median follow-up time was 36.8 months. Presence of a positive NSLN was significantly associated with poor outcome, although long-term survival was possible. Presence of ulceration, high mitotic rate, angiolymphatic invasion, total number of positive nodes, and volume of disease>1% in the SLN were significant predictors of survival on univariate analysis, but lost significance on multivariate. Multivariate Cox analysis revealed several predictors of overall survival: increasing age [hazard ratio (HR) 1.04, P<0.01], Breslow depth (HR 1.76, P<0.01), presence of extracapsular extension in the SLN (HR 2.39, P<0.01), and positive NSLN (HR 1.92, P<0.01). CONCLUSION Among node-positive melanoma patients, presence of a positive NSLN is a highly significant poor prognostic sign, even after considering the total number of positive nodes and volume of disease in the SLN. CLND after a positive SLN provides this important prognostic information.
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Affiliation(s)
- Amir A Ghaferi
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
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110
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Sentinel lymph node biopsy and completion lymph node dissection for malignant melanoma are not standard of care. Clin Dermatol 2009; 27:350-4. [DOI: 10.1016/j.clindermatol.2009.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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111
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Radical dissection after positive groin sentinel biopsy in melanoma patients: rate of further positive nodes. Melanoma Res 2009; 19:112-8. [DOI: 10.1097/cmr.0b013e328329fe7d] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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112
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113
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Sentinel Lymph Node Biopsy in Melanoma. Curr Treat Options Oncol 2008; 9:243-50. [DOI: 10.1007/s11864-008-0074-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Accepted: 10/06/2008] [Indexed: 11/25/2022]
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114
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Ariyan C, Brady MS, Gönen M, Busam K, Coit D. Positive nonsentinel node status predicts mortality in patients with cutaneous melanoma. Ann Surg Oncol 2008; 16:186-90. [PMID: 18979135 DOI: 10.1245/s10434-008-0187-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 09/12/2008] [Accepted: 09/15/2008] [Indexed: 01/26/2023]
Abstract
While sentinel lymph node biopsy (SLN) is a highly accurate and well-tolerated procedure for patients with cutaneous melanoma, the role of the completion lymph node dissection (CLND) for patients with positive SLN biopsy remains unknown. This study aimed to look at the prognostic value of a positive nonsentinel lymph node (NSLN). A prospectively maintained database identified 222 patients with cutaneous melanoma and a positive SLN biopsy, without evidence of distant disease. All of these patients underwent CLND, and 37 patients (17%) had positive NSLN. With median follow-up of 33 months, patients with negative NSLN had median survival of 104 months, while patients with positive NSLN had median survival of 36 months (p < 0.001). There were no survivors in the patients with positive NSLN beyond 6 years. When patients with an equal number of positive nodes were analyzed, the presence of a positive NSLN was still associated with worse melanoma-specific survival (66 months for NSLN- versus 34 months for NSLN+, p = 0.04). While increasing age, tumor thickness, and male sex were associated with an increased risk of death on multivariate analysis, a positive NSLN was the most important predictor of survival (hazard ratio 2.5). We conclude that positive NSLN is an independent predictor of disease-specific survival in patients with cutaneous melanoma.
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Affiliation(s)
- Charlotte Ariyan
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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115
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Gershenwald JE, Andtbacka RHI, Prieto VG, Johnson MM, Diwan AH, Lee JE, Mansfield PF, Cormier JN, Schacherer CW, Ross MI. Microscopic tumor burden in sentinel lymph nodes predicts synchronous nonsentinel lymph node involvement in patients with melanoma. J Clin Oncol 2008; 26:4296-303. [PMID: 18606982 DOI: 10.1200/jco.2007.15.4179] [Citation(s) in RCA: 152] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE We and others have demonstrated that additional positive lymph nodes (LNs) are identified in only 8% to 33% of patients with melanoma who have positive sentinel LNs (SLNs) and undergo complete therapeutic LN dissection (cTLND). We sought to determine predictors of additional regional LN involvement in patients with positive SLNs. PATIENTS AND METHODS Patients with clinically node-negative melanoma who underwent SLN biopsy (1991 to 2003) and had positive SLNs were identified. Clinicopathologic factors, including extent of microscopic disease within SLNs, were evaluated as potential predictors of positive non-SLNs. RESULTS Overall, 359 (16.3%) of the 2,203 patients identified had a positive SLN. Positive non-SLNs were identified in 48 (14.0%) of the 343 patients with positive SLNs who underwent cTLND. On univariate analysis, several measures of SLN microscopic tumor burden, one versus three or more SLNs harvested, tumor thickness more than 2 mm, age older than 50 years, and Clark level higher than III were predictive of positive non-SLNs; primary tumor ulceration and number of positive SLNs had no apparent impact. On multivariable logistic regression analysis, measures of SLN microscopic tumor burden were the most significant independent predictors of positive non-SLNs; tumor thickness more than 2 mm and number of SLNs harvested also predicted additional disease. A model was developed that stratified patients according to their risk for non-SLN involvement. CONCLUSION In melanoma patients with positive SLNs, SLN tumor burden, primary tumor thickness, and number of SLNs harvested may be useful in identifying a group at low risk for positive non-SLNs and be spared the potential morbidity of a cTLND.
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Affiliation(s)
- Jeffrey E Gershenwald
- Department of Surgical Oncology, Division of Quantitative Sciences, Unit 444, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
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116
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Pizarro Á. ¿Por qué la biopsia del ganglio centinela no aumenta la supervivencia en pacientes con melanoma? ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s0001-7310(08)74692-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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117
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Bilimoria KY, Balch CM, Bentrem DJ, Talamonti MS, Ko CY, Lange JR, Winchester DP, Wayne JD. Complete lymph node dissection for sentinel node-positive melanoma: assessment of practice patterns in the United States. Ann Surg Oncol 2008; 15:1566-76. [PMID: 18414952 DOI: 10.1245/s10434-008-9885-2] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Revised: 02/22/2008] [Accepted: 02/23/2008] [Indexed: 01/05/2023]
Abstract
BACKGROUND Currently, complete lymph node dissection (CLND) is recommended after identification of a metastatic lymph node by sentinel lymph node biopsy (SLNB). Guidelines suggest that CLND should be performed as a separate procedure, and a sufficient number of nodes should be examined. Our objective was to examine the utilization, timing, and adequacy of CLND for melanoma in the United States. METHODS From the National Cancer Data Base, patients diagnosed with stage I to III melanoma during 2004-2005 were identified. Multiple logistic regression was used to assess factors associated with CLND utilization, timing (separate operation from SLNB), and adequacy (examination of > or = 10 nodes). RESULTS Of the 44,548 patients identified, 47.5% were pathologic stage IA, 23.8% stage IB, 14.1% stage II, and 14.6% stage III. Of the 17% (2942 of 17,524) with nodal metastases on SLNB, only 50% underwent a CLND. Patients were significantly less likely to undergo a CLND after SLNB if > 75 years old or had lower extremity melanomas. Of the patients who underwent a CLND, only 42% underwent the CLND at a separate procedure after the SLNB. Of those who underwent a CLND, 69.2% had > or = 10 nodes examined. Patients were significantly less likely to have > or = 10 nodes examined if they were > 75 years old or had lower extremity melanomas. Patients treated at NCCN/NCI-designated centers were significantly more likely to undergo nodal evaluation in concordance with established guidelines. CONCLUSIONS Only half of patients with sentinel node-positive melanoma underwent CLND. Quality surveillance measures are needed to monitor, standardize, and improve the care of patients with malignant melanoma.
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118
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Morbidity and Recurrence After Completion Lymph Node Dissection Following Sentinel Lymph Node Biopsy in Cutaneous Malignant Melanoma. Ann Surg 2008; 247:687-93. [DOI: 10.1097/sla.0b013e318161312a] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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119
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Riber-Hansen R, Sjoegren P, Hamilton-Dutoit SJ, Steiniche T. Extensive Pathological Analysis of Selected Melanoma Sentinel Lymph Nodes: High Metastasis Detection Rates at Reduced Workload. Ann Surg Oncol 2008; 15:1492-501. [DOI: 10.1245/s10434-008-9847-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Revised: 02/06/2008] [Accepted: 02/06/2008] [Indexed: 11/18/2022]
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120
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Manganoni AM, Farisoglio C, Tucci G, Facchetti F, Farfaglia R, Pizzocaro C, Ungari M, Calzavara-Pinton PG. Melanoma patients with melanoma micrometastases in sentinel node that refused completion lymphadenectomy. J Eur Acad Dermatol Venereol 2008; 22:1008-9. [PMID: 18201174 DOI: 10.1111/j.1468-3083.2007.02538.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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121
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Pizarro Á. Why Does Sentinel Lymph Node Biopsy Not Increase Survival in Patients With Melanoma? ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s1578-2190(08)70266-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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122
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Scheri RP, Essner R, Turner RR, Ye X, Morton DL. Isolated tumor cells in the sentinel node affect long-term prognosis of patients with melanoma. Ann Surg Oncol 2007; 14:2861-6. [PMID: 17882497 DOI: 10.1245/s10434-007-9472-y] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Accepted: 05/06/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND The clinical significance of isolated tumor cells (ITCs) in the melanoma-draining sentinel nodes (SNs) is unclear. METHODS Records of patients who underwent SN biopsy (SNB) for stage I/II melanoma at our institute between 1991 and 2003 were reviewed to identify patients whose SNs were tumor-free or contained only ITC (<or=0.2 mm). Tumor-positive SNs were reevaluated by the study pathologist to confirm the diagnosis and microstage the SN. Characteristics of the primary melanoma, tumor status of regional lymph nodes, and other prognostic variables were recorded. Melanoma-specific survival (MSS) rates were compared by the log-rank test. RESULTS Of 1,382 patients who underwent SNB, 1,168 (85%) had tumor-free SNs; among the 214 remaining patients with tumor-positive SNs, 57 had metastases limited to ITC. Completion lymphadenectomy (CLND) was performed in 52 of 57 patients: six (12%) had metastases in nonsentinel nodes (NSNs). At a median follow-up of 57 months, 5-year and 10-year MSS was significantly higher (P = .02) for the 1168 patients with tumor-negative SNs (94 +/- 1% and 87 +/- 2%, respectively) than the 57 patients with ITC-positive SNs (89 +/- 4% and 80 +/- 7%, respectively). Multivariate analysis identified ITC (P = .002), Breslow's thickness (P < .0001), ulceration (P < .0001), and primary site (P = .04) as significant for MSS. CONCLUSION Patients with ITC in SNs have a significantly higher risk of melanoma-specific death than those with tumor-negative SNs. The 12% incidence of nonsentinel node metastasis is similar to rates reported for patients with more extensive SN involvement. Patients with ITC should be considered for CLND.
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Affiliation(s)
- Randall P Scheri
- Department of Surgical Oncology, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA, USA.
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123
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Morton DL, Scheri RP, Balch CM. Can Completion Lymph Node Dissection Be Avoided for a Positive Sentinel Node in Melanoma? Ann Surg Oncol 2007; 14:2437-9. [PMID: 17574500 DOI: 10.1245/s10434-007-9474-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Accepted: 04/05/2007] [Indexed: 11/18/2022]
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Tsutsumida A, Furukawa H, Yamamoto Y, Horiuchi K, Yoshida T, Fujii S. Low incidence of nonsentinel node-positivity after complete lymph node dissection in melanoma patients with positive sentinel nodes. Int J Clin Oncol 2007; 12:242-3. [PMID: 17566852 DOI: 10.1007/s10147-006-0639-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2006] [Accepted: 11/08/2006] [Indexed: 11/25/2022]
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125
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Gold JS, Jaques DP, Busam KJ, Brady MS, Coit DG. Yield and Predictors of Radiologic Studies for Identifying Distant Metastases in Melanoma Patients with a Positive Sentinel Lymph Node Biopsy. Ann Surg Oncol 2007; 14:2133-40. [PMID: 17453294 DOI: 10.1245/s10434-007-9399-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Accepted: 01/02/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND It is common to obtain radiological studies around the time of a positive sentinel lymph node biopsy (SLNB) to exclude patients with distant metastases from completion lymph node dissection. The yield of such a work-up is unknown. METHODS Patients were identified from a prospectively maintained database. Medical records were reviewed. RESULTS Over an 8-year period, 181 patients had a positive SLNB. At least one study (computed tomography or magnetic resonance imaging of the brain; chest x-ray; computed tomography of the thorax, abdomen, or pelvis; positron-emission tomography scan; or bone scan) was obtained around the time of SLNB in 178 patients (98%). Studies were obtained after SLNB in 107 patients (59%). Studies ordered after SLNB resulted in indeterminate findings in 51 patients (48% of those studied). Among patients tested after SLNB, four were found to have metastatic disease (positive rate 3.7%). All of these patients had both a thick melanoma and macrometastasis within the SLN. The number of patients with indeterminate findings would be decreased and the yield of the work-up increased by 4 fold, by restricting the work-up to those with thick melanoma and macrometastasis. CONCLUSIONS Radiological studies obtained after a positive SLN produce indeterminate findings in about half of the patients and identify distant disease in 3.7%. Restricting work-up to patients with thick melanoma and macrometastasis on SLNB would spare patients from indeterminate findings and increase the yield of the evaluation.
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Affiliation(s)
- Jason S Gold
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
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126
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Henderson MA. Completion Lymphadenectomy for Melanoma Patients With a Positive Sentinel Node Biopsy Remains Standard of Care. Ann Surg Oncol 2006; 13:761-3. [PMID: 16614873 DOI: 10.1245/aso.2006.09.915] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2005] [Accepted: 11/07/2005] [Indexed: 11/18/2022]
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