Emery RE, Stevens JS, Nance RW, Corless CL, Vetto JT. Sentinel node staging of primary melanoma by the “10% rule”: pathology and clinical outcomes.
Am J Surg 2007;
193:618-22; discussion 622. [PMID:
17434368 DOI:
10.1016/j.amjsurg.2007.01.001]
[Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Revised: 01/29/2007] [Accepted: 01/29/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND
Surgical staging of clinically node-negative primary melanoma involves identification and removal of "sentinel" lymph nodes (SLNs). Although some suggest removal of only the "hottest" SLN, the "10% rule" dictates that nodes are removed until the background count is 10% or less of the count of the "hottest" node.
METHODS
To determine the utility of the 10% rule, a university database of clinically node-negative melanomas surgically staged by using this rule was examined.
RESULTS
Twenty-two of 177 cases (12.5%; 15% of T2 and T3 lesions) were SLN positive. Among the SLN-positive cases, use of the rule resulted in removal of 21 additional nodes, 7 of which contained tumor. In 3 cases (14%), the positive SLN was not the "hottest" node. At 49 months of mean follow-up time, overall survival was 63% for SLN-positive patients versus 92% for SLN-negative patients (P = .01).
CONCLUSIONS
Sentinel node staging of melanoma by the 10% rule provides significant prognostic information and a modest increase in tumor detection compared with removal of only the "hottest" node.
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